体质量指数与原发性脑干出血患者的临床特征、影像学特征和预后的关系

Relationship between body mass index and clinical characteristics,imaging characteristics and prognosis of patients with primary brainstem hemorrhage

目的探究体质量指数(BMI)与原发性脑干出血(PBH)患者的临床特征、影像学特征和预后的关系。方法回顾性分析2016年2月至2019年10月联勤保障部队第九○九医院(厦门大学附属东南医院)收治的114例PBH患者的临床资料,根据患者BMI分为正常组(BMI<24 kg/m2)71例和超重/肥胖组(BMI≥24 kg/m2)43例。比较两组患者的临床特征和影像学特征,采用单因素分析和Cox多因素回归模型分析影响PBH患者预后的因素。结果超重/肥胖组患者高血压病史(86.05%比69.01%,P=0.041)、糖尿病病史(37.21%比9.86%,P<0.01)、心脏病病史(20.93%比5.63%,P=0.013)比例均高于正常组;超重/肥胖组患者收缩压[(172.83±26.15)mmHg(1 mmHg=0.133 kPa)比(159.28±31.67)mmHg,P=0.020]、舒张压[(98.36±15.57)mmHg比(89.52±13.26)mmHg,P=0.002]、血糖[(8.64±1.53)mmol/L比(7.95±1.28)mmol/L,P=0.011]、低密度脂蛋白胆固醇(LDL-C)[(3.51±1.29)mmol/L比(2.95±1.04)mmol/L,P=0.012]、三酰甘油(TG)[(5.94±2.27)mmol/L比(2.19±0.86)mmol/L,P<0.01]、腰臀比(WHR)(1.29±0.21比2.19±0.86,P<0.01)以及昏迷(48.84%比25.35%,P=0.010)、抽搐(30.23%比14.08%,P=0.037)、中枢性高热(44.19%比23.94%,P=0.024)比例均高于正常组患者,格拉斯哥昏迷指数(GCS)评分低于正常组患者[(4.69±1.87)分比(6.37±1.52)分,P<0.01];超重/肥胖组与正常组在出血部位(χ^(2)=5.64,P=0.010)、出血量(χ^(2)=5.35,P=0.013)、合并脑室出血(χ^(2)=9.21,P=0.002)、合并脑积水(χ^(2)=4.79,P=0.029)比较差异均有统计学意义。多因素分析显示,BMI(OR=4.11,95%CI 3.84~4.64,P=0.039)、高血压病史(OR=8.71,95%CI 6.28~9.52,P=0.021)、GCS评分(OR=0.05,95%CI 0.03~0.12,P=0.012)、出血量(OR=3.09,95%CI 2.16~4.03,P=0.041)、合并脑室出血(OR=4.34,95%CI 2.96~5.12,P=0.023)、合并脑积水(OR=6.40,95%CI 5.63~6.89,P=0.027)均是影响PBH患者预后的独立危险因素。结论BMI是影响PBH预后的独立因素。超重/肥胖PBH患者同时兼具有高血压病史、GCS评分低、出血量大、合并脑室出血、合并脑积水等,更应引起临床医师的重视,积极控制病情进展,改善患者预后。

Objective To explore the relationship between body mass index(BMI)and clinical characteristics,imaging characteristics and prognosis of patients with primary brainstem hemorrhage(PBH).Methods The clinical data of 114 PBH patients admitted in 909th Hospital of PLA(the Affiliated Dongnan Hospital of Xiamen University)from February 2016 to October 2019 were retrospectively analyzed.According to the BMI,the patients were divided into the normal group(BMI<24 kg/m2,71 cases)and the overweight/obese group(BMI≥24 kg/m2,43 cases).The clinical and imaging characteristics of the two groups were compared,and the factors affecting the prognosis of the PBH patients were analyzed by univariate analysis and Cox multivariate regression model.Results More patients in the overweight/obese group had histories of hypertension(86.05%vs.69.01%,P=0.041),diabetes(37.21%vs.9.86%,P<0.01),and heart disease(20.93%vs.5.63%,P=0.013)than the normal group.The systolic blood pressure,diastolic blood pressure,blood glucose,LDL,TG,WHR,and the incidences of coma,convulsions,central fever in overweight/obese group were significantly higher than those in normal group:(172.83±26.15)mmHg(1 mmHg=0.133 kPa)vs.(159.28±31.67)mmHg,(98.36±15.57)mmHg vs.(89.52±13.26)mmHg,(8.64±1.53)mmol/L vs.(7.95±1.28)mmol/L,(3.51±1.29)mmol/L vs.(2.95±1.04)mmol/L,(5.94±2.27)mmol/L vs.(2.19±0.86)mmol/L,1.29±0.21 vs.2.19±0.86,48.84%vs.25.35%,30.23%vs.14.08%,and 44.19%vs.23.94%,the GCS score was significantly lower than that in the normal group:(4.69±1.87)scores vs.(6.37±1.52)scores,and there was statistical difference(P<0.05 or<0.01).Compared with the normal group,there were significant differences in the bleeding site(χ^(2)=5.64,P=0.010),bleeding volume(χ^(2)=5.35,P=0.013),combined ventricular hemorrhage(χ^(2)=9.21,P=0.002)and hydrocephalus(χ^(2)=4.79,P=0.029).Multivariate analysis showed that BMI(OR=4.11,95%CI 3.84 to 4.64,P=0.039),history of hypertension(OR=8.71,95%CI 6.28 to 9.52,P=0.021),GCS score(OR=0.05,95%CI 0.03 to 0.12,P=0.012),bleeding volume(OR=3.09,95%CI 2.16 to 4.03,P=0.041),combined ventricular hemorrhage(OR=4.34,95%CI 2.96 to 5.12,P=0.023)and hydrocephalus(OR=6.40,95%CI 5.63 to 6.89,P=0.027)were all independent risk factors affecting the prognosis of PBH patients.Conclusions BMI has a greater impact on the prognosis of PBH.Overweight/obese PBH patients also have hypertension history,low GCS score,large amount of bleeding,ventricular hemorrhage,hydrocephalus,etc.,which should be paid more attention to by clinicians,positively control the progress of the disease and improve the prognosis of patients.