郝新宇 于士柱 李華 蔡桂淑
·臨床研究·
體重指數(shù)和腹圍指數(shù)對(duì)缺血性卒中部位和病因的影響
郝新宇 于士柱 李華 蔡桂淑
目的探討體重指數(shù)(BMI)和腹圍指數(shù)(AGI)對(duì)缺血性卒中部位和病因的影響,以判斷二者能否預(yù)測(cè)缺血性卒中病因和發(fā)病機(jī)制。方法共185例急性缺血性卒中患者和性別、年齡、既往史相匹配的155例正常對(duì)照者,測(cè)量身高和體重并計(jì)算體重指數(shù),測(cè)量腹圍并計(jì)算腹圍指數(shù),進(jìn)行英國(guó)牛津郡社區(qū)腦卒中項(xiàng)目(OCSP)分型和TOAST分型。結(jié)果缺血性卒中患者超重(BMI 24.00~27.90 kg/m2)亞組(t=2.060,P=0.000)和肥胖(BMI≥28 kg/m2)亞組(t=2.315,P=0.000)體重指數(shù)均高于正常對(duì)照者,腹圍異常(AGI>1 cm/kg)亞組腹圍指數(shù)高于正常對(duì)照者(t=1.021,P=0.000)。185例急性缺血性卒中患者據(jù)OCSP分型分為完全前循環(huán)梗死型(TACI型)10例(5.41%)、部分前循環(huán)梗死型(PACI型)81例(43.78%)、腔隙性梗死型(LACI型)56例(30.27%)和后循環(huán)梗死型(POCI型)38例(20.54%);不同體重指數(shù)患者僅PACI型比例差異有統(tǒng)計(jì)學(xué)意義(H=7.041,P=0.011),24.00~27.90 kg/m2亞組PACI型比例高于<18.50 kg/m2亞組(Z=4.823,P=0.028)、18.50~23.90 kg/m2亞組(Z=3.157,P=0.026)和≥28 kg/m2亞組(Z=2.076,P=0.015);不同腹圍指數(shù)患者僅POCI型比例>1 cm/kg亞組高于≤1 cm/kg亞組(χ2=6.624,P=0.010)。據(jù)TOAST分型分為大動(dòng)脈粥樣硬化型(LAA型)59例(31.89%)、小動(dòng)脈閉塞型(SAO型)57例(30.81%)、心源性栓塞型(CE型)32例(17.30%)、其他明確病因型(SOE型)17例(9.19%)和不明病因型(SUE型)20例(10.81%);不同體重指數(shù)患者LAA型(H=21.597,P=0.000)和SAO型(H=29.908,P=0.000)比例差異具有統(tǒng)計(jì)學(xué)意義,其中,≥28 kg/m2亞組LAA型比例高于<18.50 kg/m2亞組(Z=9.263,P=0.020)、18.50~23.90 kg/m2亞組(Z=18.780,P=0.000)和24.00~27.90 kg/m2亞組(Z=6.817,P=0.009),18.50~23.90 kg/m2亞組SAO型比例高于<18.50 kg/m2亞組(Z=7.404,P=0.007)、24.00~27.90 kg/m2亞組(Z=22.849,P=0.000)以及≥28 kg/m2亞組(Z=12.025,P=0.001);不同腹圍指數(shù)患者>1 cm/kg亞組LAA型比例高于(χ2=11.461,P=0.001)、SOE型比例低于(χ2=4.558,P=0.033)≤1 cm/kg亞組。結(jié)論體重指數(shù)和腹圍指數(shù)均可以影響缺血性卒中部位和病因,可以用于預(yù)測(cè)缺血性卒中病因和發(fā)病機(jī)制。
卒中; 腦缺血; 體重; 腹部; 人體測(cè)量術(shù)
缺血性卒中發(fā)病率、病死率和復(fù)發(fā)率均較高,給個(gè)人、家庭和社會(huì)帶來(lái)沉重負(fù)擔(dān)。明確缺血性卒中病因和發(fā)病機(jī)制是治療和預(yù)防復(fù)發(fā)的關(guān)鍵,因此,探尋一種簡(jiǎn)便、易行的方法以盡早明確缺血性卒中的病因和發(fā)病機(jī)制,有利于早期治療。體重指數(shù)(BMI)和腹圍指數(shù)(AGI)與高血壓、糖尿病、冠心病等缺血性卒中相關(guān)危險(xiǎn)因素直接相關(guān),且二者計(jì)算簡(jiǎn)便、易于操作,鑒于此,本研究選擇體重指數(shù)和腹圍指數(shù)作為測(cè)量指標(biāo),探討其對(duì)缺血性卒中部位和病因的影響,判斷二者能否預(yù)測(cè)缺血性卒中病因和發(fā)病機(jī)制,以為臨床早期治療提供依據(jù)。
1.納入標(biāo)準(zhǔn) (1)急性缺血性卒中的診斷符合《中國(guó)急性缺血性腦卒中診治指南2010》[1]:急性起?。òl(fā)病至入院時(shí)間<48 h);存在局灶性或全面性神經(jīng)功能缺損;臨床癥狀與體征持續(xù)數(shù)小時(shí)以上;頭部CT和(或)MRI可見(jiàn)責(zé)任梗死灶。(2)首次發(fā)作。(3)本研究經(jīng)天津市北辰醫(yī)院道德倫理委員會(huì)審核批準(zhǔn),所有受試者或其家屬均知情同意并簽署知情同意書。
2.排除標(biāo)準(zhǔn) (1)發(fā)病至入院時(shí)間≥48 h的患者。(2)非首次發(fā)作的缺血性卒中患者。(3)顱腦創(chuàng)傷導(dǎo)致的繼發(fā)性缺血性卒中患者。(4)繼發(fā)性高血壓患者。(5)目前參加其他臨床試驗(yàn)的患者。(6)發(fā)生出血性轉(zhuǎn)化(HT)的患者。
3.一般資料 (1)缺血性卒中組:選擇天津市北辰醫(yī)院神經(jīng)內(nèi)科2014年1月-2015年12月住院治療的急性缺血性卒中患者共185例,男性90例,女性95例;年齡38~78歲,平均(68.52±10.21)歲;發(fā)病至入院時(shí)間1~48 h,平均(12.25±2.56)h;既往有高血壓103例(55.68%)、糖尿病23例(12.43%)、冠心病41例(22.16%)、心房顫動(dòng)9例(4.86%)、高脂血癥56例(30.27%),吸煙56例(30.27%)、飲酒34例(18.38%)。(2)正常對(duì)照組(對(duì)照組):選擇同期在我院進(jìn)行體格檢查的健康志愿者155例,男性87例,女性68例;年齡38~75歲,平均(65.94±8.43)歲;既往有高血壓86例(55.48%)、糖尿病16例(10.32%)、冠心病25例(16.13%)、心房顫動(dòng)5例(3.23%)、高脂血癥45例(29.03%),吸煙35例(22.58%)、飲酒30例(19.35%)。兩組受試者性別、年齡和既往史比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05,表1),具有可比性。
1.體重指數(shù)和腹圍指數(shù)的測(cè)量 (1)體重指數(shù)的測(cè)量:囑受試者脫鞋、輕便衣裝,測(cè)量身高(精確至0.50 cm)和體重(精確至0.50 kg),并計(jì)算體重指數(shù),計(jì)算公式為體重指數(shù)(kg/m2)=體重(kg)/身高(m)2。參照《中國(guó)成人超重與肥胖癥預(yù)防與控制指南(節(jié)錄)》[2]推薦的標(biāo)準(zhǔn),<18.50 kg/m2,體重過(guò)輕;18.50~23.90 kg/m2,體重正常;24.00~ 27.90 kg/m2,超重;≥ 28 kg/m2,肥胖。(2)腹圍指數(shù)的測(cè)量:于餐后2 h囑受試者站立位,著單衣、松褲帶,平和呼吸,以皮尺平臍部繞腹部測(cè)量腹圍(精確至0.10 cm),并計(jì)算腹圍指數(shù),計(jì)算公式為腹圍指數(shù)(cm/kg)=實(shí)際測(cè)量腹圍(cm)/[0.54×體重(kg)×41.70],參照《中國(guó)人理想腹圍的推定及腹圍指數(shù)的建立》[3]推薦的標(biāo)準(zhǔn),>1 cm/kg為腹圍異常。
2.缺血性卒中的分型 (1)按照部位分型:參照英國(guó)牛津郡社區(qū)腦卒中項(xiàng)目(OCSP)分型[4],分為完全前循環(huán)梗死型(TACI型)、部分前循環(huán)梗死型(PACI型)、腔隙性梗死型(LACI型)和后循環(huán)梗死型(POCI型)共4種亞型。(2)按照病因分型:參照TOAST分型[5],分為大動(dòng)脈粥樣硬化型(LAA型)、心源性栓塞型(CE型)、小動(dòng)脈閉塞型(SAO型)、其他明確病因型(SOE型)和不明病因型(SUE型)共計(jì)5種亞型。
本組數(shù)據(jù)采用SPSS 16.0統(tǒng)計(jì)軟件進(jìn)行處理與分析。計(jì)數(shù)資料以相對(duì)數(shù)構(gòu)成比(%)或率(%)表示,采用χ2檢驗(yàn)或校正χ2檢驗(yàn);呈正態(tài)分布的計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,采用兩獨(dú)立樣本的t檢驗(yàn)。不同體重指數(shù)亞組缺血性卒中分型的比較,采用Kruskal-Wallis秩和檢驗(yàn)(H檢驗(yàn)),兩兩比較行秩和檢驗(yàn);不同腹圍指數(shù)亞組缺血性卒中分型的比較,采用秩和檢驗(yàn)。以P≤0.05為差異具有統(tǒng)計(jì)學(xué)意義。
表1 兩組受試者一般資料的比較Table 1.Comparison of general data between 2 groups
根據(jù)體重指數(shù),兩組受試者分為體重過(guò)輕(<18.50 kg/m2)、體重正常(18.50~ 23.90 kg/m2)、超重(24.00~27.90 kg/m2)和肥胖(≥28 kg/m2)4個(gè)亞組,24.00~27.90 kg/m2亞組(P=0.000)和≥28 kg/m2亞組(P=0.000)缺血性卒中患者體重指數(shù)均高于正常對(duì)照者且差異具有統(tǒng)計(jì)學(xué)意義,而<18.50 kg/m2亞組和18.50~23.90 kg/m2亞組缺血性卒中患者與正常對(duì)照者體重指數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義(均P>0.05,表2)。根據(jù)腹圍指數(shù),兩組受試者分為腹圍正常(≤1 cm/kg)和腹圍異常(>1 cm/kg)2個(gè)亞組,其中,>1 cm/kg亞組缺血性卒中患者腹圍指數(shù)高于正常對(duì)照者且差異具有統(tǒng)計(jì)學(xué)意義(P=0.000),而≤1 cm/kg亞組缺血性卒中患者與正常對(duì)照者腹圍指數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05,表3)。
1.體重指數(shù)和腹圍指數(shù)對(duì)OCSP分型的影響
本組185例急性缺血性卒中患者根據(jù)OCSP分型,可以分為 TACI型 10例(5.41%)、PACI型 81例(43.78%)、LACI型56例(30.27%)和POCI型38例(20.54%)。不同體重指數(shù)亞組患者OCSP分型相比較,僅PACI型比例差異具有統(tǒng)計(jì)學(xué)意義(P=0.011),其中24.00~27.90 kg/m2亞組PACI型比例高于<18.50 kg/m2亞組(Z=4.823,P=0.028)、18.50~23.90 kg/m2亞組(Z=3.157,P=0.026)和≥28 kg/m2亞組(Z=2.076,P=0.015);而TACI型、LACI型和POCI型比例組間差異未達(dá)到統(tǒng)計(jì)學(xué)意義(均P>0.05,表4)。不同腹圍指數(shù)亞組患者OCSP分型比較,>1 cm/kg亞組僅POCI型比例高于≤1 cm/kg亞組且差異具有統(tǒng)計(jì)學(xué)意義(P=0.010),而TACI型、PACI型和LACI型比例組間差異無(wú)統(tǒng)計(jì)學(xué)意義(均P>0.05,表4)。
2.體重指數(shù)和腹圍指數(shù)對(duì)TOAST分型的影響 本組185例急性缺血性卒中患者根據(jù)TOAST分型,可以分為L(zhǎng)AA型59例(31.89%)、SAO型57例(30.81%)、CE型 32例(17.30%)、SOE型 17例(9.19%)和SUE型20例(10.81%)。不同體重指數(shù)亞組患者TOAST分型相比較,LAA型(P=0.000)和SAO型(P=0.000)比例差異具有統(tǒng)計(jì)學(xué)意義,其中,≥28 kg/m2亞組LAA型比例高于<18.50 kg/m2亞組(Z=9.263,P=0.020)、18.50~ 23.90 kg/m2亞組(Z=18.780,P=0.000)和24.00~ 27.90 kg/m2亞組(Z=6.817,P=0.009),18.50~23.90 kg/m2亞組SAO型比例高于 <18.50 kg/m2亞組(Z=7.404,P=0.007)、24.00~27.90 kg/m2亞組(Z=22.849,P=0.000)和 ≥ 28 kg/m2亞組(Z=12.025,P=0.001);而CE型、SOE型和SUE型比例組間差異無(wú)統(tǒng)計(jì)學(xué)意義(均P>0.05,表5)。不同腹圍指數(shù)亞組患者TOAST分型比較,>1 cm/kg亞組LAA型比例高于(P=0.001)、SOE型比例低于(P=0.033)≤1 cm/kg亞組且差異具有統(tǒng)計(jì)學(xué)意義,而SAO型、CE型和SUE型比例組間差異無(wú)統(tǒng)計(jì)學(xué)意義(均P>0.05,表5)。
表2 不同體重指數(shù)亞組缺血性卒中患者與正常對(duì)照者體重指數(shù)的比較(x±s,kg/m2)Table 2. Comparison of BMI between ischemic stroke and control groups among different BMI subgroups(x±s,kg/m2)
表3 不同腹圍指數(shù)亞組缺血性卒中患者與正常對(duì)照者腹圍指數(shù)的比較(x±s,cm/kg)Table 3. Comparison of AGI between ischemic stroke and control groups among different AGI subgroups(x±s,cm/kg)
體重指數(shù)是與體內(nèi)脂肪總量密切相關(guān)的指標(biāo),綜合考慮身高和體重兩項(xiàng)因素,該項(xiàng)指標(biāo)簡(jiǎn)便、實(shí)用,可以反映出超重和肥胖,在評(píng)價(jià)機(jī)體因超重而面臨高血壓、糖尿病、心臟病等風(fēng)險(xiǎn)時(shí),較單純測(cè)量體重更準(zhǔn)確[6]。但體重指數(shù)作為反映超重或肥胖的公認(rèn)指標(biāo),不能特異性反映向心性肥胖,而向心性肥胖對(duì)健康的危害更顯著[7]。目前關(guān)于向心性肥胖的研究多采用腹圍指數(shù),但該項(xiàng)指標(biāo)目前尚無(wú)統(tǒng)一標(biāo)準(zhǔn)。因此,本研究以體重指數(shù)作為主要指標(biāo),同時(shí)計(jì)算腹圍指數(shù),從兩方面明確二者對(duì)缺血性卒中部位和病因的影響。多項(xiàng)流行病學(xué)調(diào)查和臨床試驗(yàn)顯示,體重指數(shù)和腹圍指數(shù)與高血壓、糖尿病、心血管病、高脂血癥等缺血性卒中相關(guān)危險(xiǎn)因素有關(guān)[8-11]。腦卒中肥胖患者血清脂質(zhì)、血糖、血清尿酸、血漿同型半胱氨酸和血液黏稠度均顯著升高[12-14]。不同于傳統(tǒng)腦血管病危險(xiǎn)因素,如性別、年齡、種族、高血壓、糖尿病、心臟病、高脂血癥、吸煙、飲酒等,體重指數(shù)和腹圍指數(shù)是否為腦血管病的獨(dú)立危險(xiǎn)因素,目前觀點(diǎn)尚不一致。中國(guó)肥胖問(wèn)題工作組數(shù)據(jù)匯總分析協(xié)作組[15]的報(bào)告指出,超重和肥胖是冠心病和缺血性卒中的獨(dú)立危險(xiǎn)因素。本研究結(jié)果顯示,體重指數(shù)和腹圍指數(shù)均可以影響缺血性卒中患者OCSP和TOAST分型,然而尚待大樣本臨床研究的進(jìn)一步證實(shí)。
對(duì)缺血性卒中的認(rèn)識(shí)經(jīng)歷從“疾病”到“臨床綜合征”的深入過(guò)程,并基于病因進(jìn)行“對(duì)因治療”,這一過(guò)程隨著缺血性卒中病因?qū)W研究的發(fā)展而不斷深入。因此,根據(jù)缺血性卒中部位和病因分型,對(duì)預(yù)防與治療缺血性卒中意義重大。OCSP分型是1988年Bamford等[16]對(duì)英國(guó)牛津郡大規(guī)模缺血性卒中患者進(jìn)行調(diào)查而提出的新分型,該分型特點(diǎn)與解剖學(xué)和病理生理學(xué)過(guò)程相對(duì)應(yīng),最顯著優(yōu)點(diǎn)是,簡(jiǎn)便易行,不依賴輔助檢查結(jié)果,在CT和(或)MRI尚未發(fā)現(xiàn)病灶前即可根據(jù)臨床表現(xiàn)迅速分型,并提示閉塞血管和梗死灶部位和大小,與影像學(xué)對(duì)應(yīng)關(guān)系良好,同時(shí)具有較好的信度和效度,符合臨床需求,可用于指導(dǎo)早期治療[4,17]。本組185例急性缺血性卒中患者按照OCSP分型分為TACI型10例(5.41%)、PACI型81例(43.78%)、LACI型56例(30.27%)和POCI型38例(20.54%);不同體重指數(shù)患者僅PACI型比例差異有統(tǒng)計(jì)學(xué)意義,其中,24.00~27.90 kg/m2亞組高于<18.50 kg/m2亞組、18.50~23.90 kg/m2亞組和 ≥ 28 kg/m2亞組,而TACI型、LACI型和POCI型比例組間差異無(wú)統(tǒng)計(jì)學(xué)意義,提示體重指數(shù)為24.00~27.90 kg/m2的缺血性卒中患者更易發(fā)生部分前循環(huán)梗死,而≥28 kg/m2亞組OCSP分型與<18.50 kg/m2亞組和18.50~24.90 kg/m2亞組差異無(wú)統(tǒng)計(jì)學(xué)意義,考慮可能是樣本量較小的原因;不同腹圍指數(shù)患者僅POCI型比例>1 cm/kg亞組高于≤1 cm/kg亞組,TACI型、PACI型和LACI型比例組間差異則無(wú)統(tǒng)計(jì)學(xué)意義,提示缺血性卒中向心性肥胖患者更易發(fā)生后循環(huán)梗死。
20 世紀(jì) 90年代,Adams研究團(tuán)隊(duì)[5,18]在抗凝藥Org 10172治療急性缺血性卒中的臨床試驗(yàn)中提出缺血性卒中病因分型即TOAST分型,根據(jù)臨床表現(xiàn)、梗死灶大小和類型、影像學(xué)特點(diǎn)和輔助檢查結(jié)果,分為L(zhǎng)AA型、SAO型、CE型、SOE型和SUE型。TOAST分型是目前國(guó)際公認(rèn)的首個(gè)缺血性卒中病因分型,其意義在于可以反映缺血性卒中病因和發(fā)病機(jī)制,從而為制定治療方案和二級(jí)預(yù)防提供理論依據(jù)[19]。本組185例急性缺血性卒中患者按照TOAST分型分為L(zhǎng)AA型59例(31.89%)、SAO型57例(30.81%)、CE型32例(17.30%)、SOE型 17例(9.19%)和 SUE型 20例(10.81%)。不同體重指數(shù)患者TOAST分型比較,LAA型和SAO型比例差異具有統(tǒng)計(jì)學(xué)意義,其中,≥28 kg/m2亞組患者LAA型比例高于<18.50 kg/m2亞組、18.50~23.90 kg/m2亞組和24.00~27.90 kg/m2亞組,18.50~23.90 kg/m2亞組SAO型比例高于<18.50 kg/m2亞組、24.00~27.90 kg/m2亞組和≥28 kg/m2亞組,CE型、SOE型和SUE型比例組間差異無(wú)統(tǒng)計(jì)學(xué)意義,提示體重指數(shù)≥28 kg/m2的缺血性卒中患者易發(fā)生大動(dòng)脈粥樣硬化,18.50~23.90 kg/m2的患者更易發(fā)生小動(dòng)脈閉塞;不同腹圍指數(shù)患者>1 cm/kg亞組LAA型比例高于、SOE型比例低于≤1 cm/kg亞組,而SAO型、CE型和SUE型比例組間差異無(wú)統(tǒng)計(jì)學(xué)意義,提示缺血性卒中向心性肥胖患者更易發(fā)生大動(dòng)脈粥樣硬化。隨著生活習(xí)慣的改變和生活條件的改善,高脂飲食導(dǎo)致肥胖尤其是腹圍指數(shù)異常的人群增多,更易發(fā)生大動(dòng)脈粥樣硬化,故LAA型風(fēng)險(xiǎn)明顯高于其他人群。
表4 不同亞組缺血性卒中患者OCSP分型的比較[例(%)]Table 4. Comparison of OCSP subtypes of ischemic stroke in different subgroups[case(%)]
表5 不同亞組缺血性卒中患者TOAST分型的比較[例(%)]Table 5. Comparison of TOAST subtypes of ischemic stroke in different subgroups[case(%)]
綜上所述,應(yīng)重視對(duì)于肥胖的宣教和干預(yù),控制體重有利于腦血管病相關(guān)危險(xiǎn)因素的控制,從而降低腦卒中風(fēng)險(xiǎn),對(duì)已發(fā)生缺血性卒中的患者,應(yīng)盡早對(duì)體重指數(shù)和腹圍指數(shù)異常患者行抗動(dòng)脈粥樣硬化治療。
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Effect of body mass index and abdominal girth index on location and etiology of ischemic stroke
HAO Xin-yu1,YU Shi-zhu2,LI Hua1,CAI Gui-shu1
1Department of Neurology,Tianjin Beichen Hospital,Tianjin 300400,China
2Tianjin Medical University General Hospital;Tianjin Neurological Institute;Tianjin Key Laboratory of Injuries,Variations and Regeneration of Nervous System;Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System,Ministry of Education,Tianjin 300052,China
Corresponding author:HAO Xin-yu(Email:lily-hxy@163.com)
ObjectiveTo investigate the influence of body mass index(BMI)and abdominal girth index(AGI)on the location and etiology of ischemic stroke in order to determine whether they can predict the etiology and pathogenesis of ischemic stroke.MethodsA total of 185 patients with acute ischemic stroke and 155 cases of normal controls matched in sex,age and past medical history were enrolled in this study.Their height and weight were measured to calculate BMI,and abdominal circumference was measured to calculate AGI.Oxfordshire Community Stroke Project(OCSP)and TOAST classification were carried out.ResultsBMI of overweight(BMI 24.00-27.90 kg/m2)subgroup(t=2.060,P=0.000)and obesity(BMI≥28 kg/m2)subgroup(t=2.315,P=0.000)in patients with ischemic stroke was significantly higher than that in control group.AGI of abnomaly(AGI>1 cm/kg)subgroup in patients with ischemic stroke was significantly higher than that in control group(t=1.021,P=0.000).Based on OCSP classification,185 patients with ischemic stroke were classified into 10(5.41%)of total anterior circulation infarct(TACI),81(43.78%)of partial anterior circulation infarct(PACI),56(30.27%)of lacunar infarct(LACI)and 38(20.54%)of posterior circulation infarct(POCI).Only the PACI ratio among different BMI subgroups had statistical significance(H=7.041,P=0.011).PACI ratio in BMI 24.00-27.90 kg/m2subgroup was significantly higher than that in BMI<18.50 kg/m2subgroup(Z=4.823,P=0.028),18.50-23.90 kg/m2subgroup(Z=3.157,P=0.026)and≥28 kg/m2subgroup(Z=2.076,P=0.015).In AGI subgroups,only POCI ratio in AGI>1 cm/kg subgroup was significantly higher than that in AGI≤ 1 cm/kg subgroup(χ2=6.624,P=0.010).In TOAST classification,185 patients with ischemic stroke were classified into 59(31.89%)of large artery atherosclerosis(LAA),57(30.81%)of small artery occlusion(SAO),32(17.30%)of cardioembolism(CE),17(9.19%)of stroke of other determined etiology(SOE)and 20(10.81%)of stroke of undetermined etiology(SUE).LAA ratio(H=21.597,P=0.000)and SAO ratio(H=29.908,P=0.000)among different BMI subgroups had statistical significance.LAA ratio in BMI≥28 kg/m2subgroup was significantly higher than that in<18.50 kg/m2subgroup(Z=9.263,P=0.020),18.50-23.90 kg/m2subgroup(Z=18.780,P=0.000)and 24.00-27.90 kg/m2subgroup(Z=6.817,P=0.009).SAO ratio in BMI 18.50-23.90 kg/m2subgroup was significantly higher than that in<18.50 kg/m2subgroup(Z=7.404,P=0.007),24.00-27.90 kg/m2subgroup(Z=22.849,P=0.000)and≥28 kg/m2subgroup(Z=12.025,P=0.001).In AGI subgroups,LAA ratio in>1 cm/kg subgroup was significantly higher(χ2=11.461,P=0.001),while SOE ratio was significantly lower(χ2=4.558,P=0.033)than that in AGI≤1 cm/kg subgroup.ConclusionsBMI and AGI can influence the location and etiology of ischemic stroke,which can be used to predict the etiology and pathogenesis of ischemic stroke.
Stroke;Brain ischemia;Body weight;Abdomen;Anthropometry
This study was supported by Science and Technology Development Project of Beichen District,Tianjin,China(No.BC2014-18).
10.3969/j.issn.1672-6731.2017.11.011
天津市北辰區(qū)科技發(fā)展計(jì)劃項(xiàng)目(項(xiàng)目編號(hào):BC2014-18)
300400天津市北辰醫(yī)院神經(jīng)內(nèi)科(郝新宇,李華,蔡桂淑);300052天津醫(yī)科大學(xué)總醫(yī)院天津市神經(jīng)病學(xué)研究所天津市神經(jīng)損傷變異與再生重點(diǎn)實(shí)驗(yàn)室教育部中樞神經(jīng)創(chuàng)傷修復(fù)與再生重點(diǎn)實(shí)驗(yàn)室(于士柱)
郝新宇(Email:lily-hxy@163.com)
2017-11-01)