肥胖与症状性颅内动脉粥样硬化压力比的关系研究

Relationship between Obesity and Pressure Ratio in Symptomatic Intracranial Atherosclerosis

目的研究肥胖与症状性颅内动脉粥样硬化狭窄(symptomatic intracranial atherosclerosis stenosis,sICAS)患者跨病变压力比(pressure ratio,PR)减低的关系。方法本研究数据来源于中国国家卒中登记Ⅲ数据库。纳入数据库中具有HR-MRI影像学资料的sICAS患者进行分析。采用TOF-MRA成像进行网格建立,采用有限元方法进行建模获得压力值。血管狭窄远端压力和近端压力的PR≤0.76表示狭窄后残余血流减低。按患者BMI分为低或正常体重组、超重组和肥胖组3组。校正年龄、性别、吸烟史、重度饮酒史、高血压病史、糖尿病病史、血脂异常和狭窄程度这些可能的混杂因素,采用logistic回归分析肥胖与PR减低的关系。结果共438例患者纳入分析,中位年龄64(57~71)岁,其中148例(33.79%)为女性。低或正常体重组、超重组和肥胖组的中位PR分别为0.90(0.78~0.96)、0.89(0.73~0.96)和0.82(0.52~0.94),3组之间差异有统计学意义(P=0.044)。多因素logistic回归分析结果显示,校正年龄、性别、吸烟史、重度饮酒史、高血压病史、糖尿病病史、血脂异常和狭窄程度,肥胖是sICAS患者PR减低的危险因素(OR 2.551,95%CI 1.328~4.902,P=0.005)。此外,根据年龄进行亚组分析,在≥65岁的患者中,校正性别、吸烟史、重度饮酒史、高血压病史、糖尿病病史、血脂异常和狭窄程度,肥胖是sICAS患者PR减低的危险因素(OR 2.913,95%CI 1.118~7.590,P=0.029);进行性别亚组分析,女性患者中,校正年龄、高血压病史、糖尿病病史、血脂异常和狭窄程度,肥胖仍是sICAS患者PR减低的危险因素(OR 3.673,95%CI 1.174~11.493,P=0.002)。结论肥胖可能是sICAS患者PR减低的危险因素。通过减肥是否可以改善sICAS患者PR、增加脑血流灌注需要进一步研究。

Objective To investigate the association between obesity and reduced translesional pressure ratio(PR)in patients with symptomatic intracranial atherosclerosis stenosis(sICAS).Methods Data from this study were obtained from the Chinese National Stroke RegistryⅢ(CNSR-Ⅲ).sICAS patients with HR-MRI data in the database were included.Three-dimensional meshes were created based on TOF-MRA,and pressure values were obtained by modeling with a finite element method.A PR of≤0.76 between distal and proximal pressure of the stenosis indicated diminished residual blood flow after stenosis.Patients were divided into low or normal weight group,overweight group and obese group according to the BMI.The association between obesity and PR reduction was analyzed by logistic regression,the confounding factors that may affect PR value such as age,sex,history of smoking,history of heavy drinking,history of hypertension,history of diabetes,dyslipidemia,and degree of stenosis were adjusted.Results A total of 438 patients[median age 64(57-71)years,148 cases(33.79%)were female]were included in the analysis.The median PR of the low or normal weight group,the overweight group and the obese group were 0.90(0.78-0.96),0.89(0.73-0.96)and 0.82(0.52-0.94),respectively,and the difference between the three groups was statistically significant(P=0.044).Multifactorial logistic regression analysis showed that after adjusting for age,sex,history of smoking,history of heavy drinking,history of hypertension,history of diabetes,dyslipidemia and degree of stenosis,obesity was the risk factor for reduced PR in sICAS patients(OR 2.551,95%CI 1.328-4.902,P=0.005).In addition,in subgroup analysis by age,adjusted for sex,smoking history,heavy drinking history,hypertension history,diabetes history,dyslipidemia,and degrees of stenosis,obesity was the risk factor for reduced PR in patients≥65 years of age(OR 2.913,95%CI 1.118-7.590,P=0.029).In subgroup analysis by gender,in female patients,adjusted for age,history of hypertension,history of diabetes,dyslipidemia and degrees of stenosis,obesity was still the risk factor for reduced PR in sICAS patients(OR 3.673,95%CI 1.174-11.493,P=0.002).Conclusions Obesity may be a risk factor for reduced PR in sICAS patients.Whether PR can be improved and cerebral perfusion increased by weight loss needs further study.