超重或肥胖对高血压性脑出血患者转归的影响

Impact of overweight or obesity on outcome in patients with hypertensive intracerebral hemorrhage

目的探讨根据体重指数(body mass index,BMI)定义的超重或肥胖与高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)患者功能转归的相关性。方法回顾性纳入2020年10月到2022年2月期间连云港市第一人民医院神经外科收治的HICH患者。根据BMI分为体重不足或正常组(<24 kg/m^(2))以及超重或肥胖组(≥24 kg/m^(2))。在发病后1年时通过改良Rankin量表评价功能转归,0~2分定义为转归良好,>2分定义为转归不良(其中6分为死亡)。应用Cox风险比例回归模型分析患者转归与BMI的相关性。结果共纳入394例HICH患者,男性263例(66.8%),年龄(60.2±12.0)岁。发病后1年时145例(36.8%)转归不良,54例(13.7%)死亡。与体重不足或正常患者相比,超重或肥胖患者既往2型糖尿病史比例以及基线舒张压、低密度脂蛋白胆固醇和肝酶水平较高,出院后早期转归较好,且1年时病死率较低(P均<0.05)。多变量分析显示,与体重不足或正常患者相比,超重或肥胖患者功能转归显著更好(风险比0.598,95%置信区间0.419~0.854;P=0.005),但全因死亡风险差异无统计学意义(风险比1.201,95%置信区间0.462~3.126;P=0.707)。结论超重或肥胖的HICH患者在发病后1年时功能转归显著更好,提示在HICH患者中同样存在肥胖悖论现象。

ObjectiveTo investigate the correlation between overweight or obesity defined by body mass index(BMI)and functional outcome in patients with hypertensive intracerebral hemorrhage(HICH).MethodsPatients with HICH admitted to the Department of Neurosurgery,the First People's Hospital of Lianyungang from October 2020 to February 2022 were included retrospectively.According to BMI,they were divided into underweight or normal group(<24 kg/m^(2))and overweight or obese group(≥24 kg/m^(2)).At one year after onset,the functional outcome were evaluated using the modified Rankin Scale.0-2 was defined as good outcome,while>2 were defined as poor outcome.Cox proportional hazards regression model was used to analyze the correlation between BMI and the outcome of patients.ResultsA total of 394 patients with HICH were enrolled,including 263 males(66.8%),aged 60.2±12.0 years.At one year after onset,145 patients(36.8%)had poor outcome and 54(13.7%)died.Compared with the underweight or normal group,the overweight or obese group had a higher proportion of previous type 2 diabetes history,as well as higher baseline diastolic blood pressure,low-density lipoprotein cholesterol and liver enzyme levels,better early outcome after discharge,and lower mortality at 1 year(all P<0.05).Multivariate analysis showed that the overweight or obese group had significantly better functional outcome compared to the underweight or normal group(hazard ratio 0.598,95%confidence interval 0.419-0.854;P=0.005),but there was no statistically significant difference in all-cause mortality risk(hazard ratio 1.201,95%confidence interval,0.462-3.126;P=0.707).ConclusionThe overweight or obese patients with HICH have significantly better functional outcome at one year after onset,indicating that the obesity paradox also exists in patients with HICH.