体重指数对不同严重程度卒中患者短期预后的影响

Effect of Body Mass Index on Short-Term Prognosis of Stroke Patients with Different Severity

目的探讨BMI对不同严重程度卒中患者3个月临床结局的影响。方法本研究是前瞻性多中心队列研究,观察发病7 d内首次卒中住院患者的BMI与3个月卒中结局的关系。根据入院时NIHSS评分,将患者分为轻度卒中(NIHSS评分<11分)组和中重度卒中(NIHSS评分≥11分)组。收集患者入院时的一般资料以及高血压、糖尿病等血管危险因素情况。记录入院时BMI、是否存在吞咽障碍及在院期间肺炎等资料,其中BMI按照四分位数分为4层。发病后3个月对患者进行随访,采集mRS评分,以mRS评分0~2分为预后良好,3~6分为预后不良。比较轻度卒中组和中重度卒中组BMI及其他基线指标的差异并探索不同水平BMI对不同严重程度卒中患者预后的影响。结果共纳入733例患者,其中男性474例(64.7%),女性259例(35.3%)。缺血性卒中552例(75.3%),出血性卒中181例(24.7%)。轻度卒中组526例,中重度卒中组207例。在校正混杂因素后,不同水平BMI对整体患者及轻度卒中患者3个月结局均无显著影响;在中重度卒中患者中,与BMI最低四分位水平患者相比,最高四分位水平患者3个月预后良好的比例降低(OR 0.376,95%CI 0.142~0.992,P=0.048)。结论不同BMI水平对不同严重程度卒中患者短期预后的影响不同,其中,在中重度卒中患者人群中,高BMI水平可能导致预后不良。

Objective To investigate the effect of BMI on the 3-month clinical outcome of stroke patients with different severity.Methods This study was a prospective multicenter cohort study to observe the relationship between BMI and 3-month clinical outcome in patients hospitalized for the first stroke within 7 days of onset.According to the NIHSS score at admission,the patients were divided into the mild stroke(NIHSS score<11 points)group and the moderate to severe stroke(NIHSS score≥11 points)group.The general data of the patients at admission and the risk factors of stroke such as hypertension and diabetes mellitus were collected.The BMI at admission,the presence of dysphagia,and pneumonia during hospitalization were recorded,and the BMI was divided into 4 levels according to quartiles.The patients were followed up 3 months after onset,and the mRS scores were collected.The mRS scores of 0-2 were considered to have a good prognosis,and 3-6 were considered to have a poor prognosis.The differences in BMI and other baseline indicators between the mild stroke group and the moderate to severe stroke group were compared.Multivariate analysis was used to explore the effect of different levels of BMI on the prognosis of stroke patients with different severity.Results A total of 733 patients were included,including 474(64.7%)males and 259(35.3%)females.There were 552(75.3%)patients with ischemic stroke and 181(24.7%).patients with hemorrhagic stroke.There were 526 patients in the mild stroke group and 207 patients in the moderate to severe stroke group.After adjusting for confounding factors,different levels of BMI had no significant effect on the 3-month outcome of the overall patients and mild stroke patients.Among patients with moderate to severe stroke,the proportion of patients with the highest quartile of BMI with a good prognosis at 3 months was lower than those with the lowest quartile of BMI(OR 0.376,95%CI 0.142-0.992,P=0.048).Conclusions Different BMI levels have different effects on the short-term prognosis of patients with different severity of stroke.Among patients with moderate to severe stroke,a high BMI level may lead to poor prognosis.