肥胖与卒中似乎颠倒的结果
2018年08月06日 【健康号】 梁志刚     阅读 8044

The Obesity–Stroke Paradox 肥胖与卒中似乎颠倒的结果

Background and Purpose—Limited data exist concerning obesity and survival in patients after acute stroke. The objective of this study was to investigate the association between obesity and survival in patients with acute first-ever stroke.

Methods—Patients were prospectively investigated based on a standard diagnostic protocol over a period of 16 years. Evaluation was performed on admission, at 7 days, at 1, 3, and 6 months after discharge, and yearly thereafter for up to 10 years after stroke. The study patients were divided into 3 groups according to body mass index (BMI): normal weight ( 25 kg/m2), overweight (25–29.9 kg/m2), and obese ( 30 kg/m2). Overall survival during follow-up was the primary end point. The secondary end point was the overall composite cardiovascular events over the study period.

Results—Based on our inclusion criteria, 2785 patients were recruited. According to BMI, 1138 (40.9%) patients were of normal weight, 1113 (41.0%) were overweight, and 504 (18.1%) were obese. NIHSS score on admission (mean, 11.28 8.65) was not different among the study groups. Early (first week) survival in obese (96.4%; 95% CI, 94.8%–97.9%) and overweight patients (92.8%; 95% CI, 91.2%–94.4%) was significantly higher compared to that of

normal-weight patients (90.2%; 95% CI, 88.4%–92.0%). Similarly, 10-year survival was 52.5% (95% CI, 46.4%– 58.6%) in obese, 47.4% (95% CI, 43.5%–51.3%) in overweight, and 41.5% (95% CI, 39.7%–45.0%) in normal-weight patients (log-rank test 17.7; P 0.0001). Overweight (HR, 0.82; 95% CI, 0.71– 0.94) and obese patients (HR, 0.71; 95% CI, 0.59–0.86) had a significantly lower risk of 10-year mortality compared to normal-weight patients after adjusting for all confounding variables.

Conclusions—Based on BMI estimation, obese and overweight stroke patients have significantly better early and long-term survival rates compared to those with normal BMI

背景与目的:由于急性卒中后病人的肥胖和生存情况的资料有限。本研究目的是调查首次中风患者肥胖与生存的关系。
方法:基于标准诊断方法,患者被前瞻性研究16年。在入院时、出院后7天,1月,3月和6月进行评估,之后每年评估1次,一直到10年。根据体重指数,研究的患者被分成3组,正常体重 (<25 kg/m(2)), 超重 (25-29.9 kg/m(2)), 肥胖 (≥30 kg/m(2))。随访过程主要终点是总的生存,次要终点是总的心血管事件。
结果:基于纳入标准,研究了2785位病人。 根据体重指数(BMI),正常体重有1138(40.9%) 位, 超重有1113(41.0%) 位,以及肥胖有504(18.1%)位 。 各研究组在入院时的NIHSS评分 (平均11.28±8.65)没有不同。肥胖组(96.4%,95%可信区间,94.8%-97.9%)和超重组(92.8%,95%可信区间,91.2%-94.4%) 的早期生存率(第一周)明显高于正常体重组(90.2%; 95%可信区间,88.4%-92.0%)。同样,10年生存率,肥胖组为52.5%(95%可信区间,46.4% 58.6%) ,超重组为47.4%(95%可信区间,43.5% 1.3%),正常体重组为 41.5% (95%可信区间, 39.7%-45.0%) (对数等级检验为17.7; P<0.0001) 。对所有混杂变量调整后,超重组(危险比为0.82,95%可信区间,0.71-0.94)和肥胖组(危险比为0.71,95%可信区间,0.59-0.86)的10年死亡率比正常体重组要低。
结论:基于体重指数(BMI)评估,肥胖和超重的卒中患者比正常体重的卒中患者有更好的早期和远期生存率。


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梁志刚
主任医师/教授
烟台毓璜顶医院
神经内科,综合卒中门...
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