摘要
目的探讨超重对急性轻型缺血性脑卒中或中高危短暂性脑缺血发作(TIA)患者预后的影响。方法纳入366例携带CYP2C19功能缺失型等位基因的急性轻型缺血性脑卒中或中高危TIA患者作为研究对象,收集患者入院基线资料和发病后3个月的临床结局资料(主要结局为发病后3个月内卒中复发,次要结局为发病后3个月内卒中复发或死亡复合结局、血管事件和3个月生活质量)。采用Kaplan-Meier法绘制累计结局发生率曲线,采用多因素COX比例风险模型和多因素Logistic回归模型评估超重与缺血性脑卒中或TIA患者发病后3个月临床结局的关系。计算综合判别改善指数(IDI)和净重分类改善指数(NRI),评估在传统模型基础上增加体质量指数(BMI,是否超重)对急性缺血性脑卒中或TIA预后的预测价值。结果随访3个月,28例患者卒中复发,1例患者死亡,31例患者发生血管事件。Kaplan-Meier累计结局发生率曲线显示,超重患者发病后3个月卒中复发、卒中复发或死亡、血管事件累计发生率均低于未超重患者,差异有统计学意义(Log-rank P<0.05)。多因素分析结果显示,与未超重患者比较,超重患者3个月卒中复发(HR=0.24,95%CI:0.08~0.71)、卒中复发或死亡复合结局(HR=0.24,95%CI:0.08~0.69)、血管事件(HR=0.22,95%CI:0.07~0.63)风险显著降低,且3个月生活质量显著提升(OR=0.39,95%CI:0.20~0.76)。IDI和NRI计算结果显示,与传统模型相比,增加BMI(是否超重)后的新模型对急性缺血性卒中或TIA预后的预测能力显著提高。结论超重可能是携带CYP2C19功能缺失型等位基因的急性轻型缺血性脑卒中或中高危TIA患者预后的保护因素。与未超重患者相比,超重患者发病后3个月内卒中复发、卒中复发或死亡复合结局、血管事件的发生风险均降低,且发病后3个月的生活质量提高。
Objective To investigate the impact of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack(TIA).Methods A total of 366 patients with acute mild ischemic stroke or moderate-high risk TIA who carried CYP2C19 loss-of-function alleles were included in the study.Baseline data were collected at admission,and clinical months post-onset;secondary outcomes:composite outcome of stroke recurrence or death within 3 months post-onset,vascular events,and quality of life within 3 months.Kaplan-Meier method was used to plot the cumulative incidence curve of outcomes.Multivariate Cox proportional hazards model and multivariate Logistic regression model were used to evaluate the relationship between overweight and clinical outcomes within 3 months post-onset in patientswith ischemic stroke or TIA.The integrated discrimination improvement index(IDI)and net reclassification improvement index(NRI)were calculated to assess the predictive value of adding body mass index(BMI,whether overweight or not)based on traditional models for predicting the prognosis of acute ischemic stroke or TIA.Results After 3 months of follow-up,28 patients had stroke recurrence,1 patient died,and 31 patients had vascular events.The Kaplan-Meier cumulative incidence curve showed that the cumulative incidences of stroke recurrence,stroke recurrence or death,and vascular events after 3 months of onset were lower in overweight patients compared with non-overweight patients(Log-rank P<0.05).Multivariate analysis showed that compared with non-overweight patients,overweight patients had significantly reduced risks of stroke recurrence within 3 months(HR=0.24;95%CI,0.08 to 0.71),composite outcome of stroke recurrence or death(HR=0.24;95%CI,0.08 to 0.69),and vascular events(HR=0.22;95%CI,0.07 to 0.63),and significantly improved quality of life within 3 months(OR=0.39;95%CI,0.20 to 0.76).The IDI and NRI calculations showed that compared with traditional models,the new model adding BMI(whether overweig
作者
穆静丽
徐青云
王瑞莉
杨嫔妮
程铭
王丹
张晋
王奕楠
赵性泉
常立国
王艾丽
MU Jingli;XU Qingyun;WANG Ruili;YANG Pinni;CHENG Ming;WANG Dan;ZHANG Jin;WANG Yinnan;ZHAO Xingquan;CHANG Liguo;WANG Aili(Liaocheng Third People′s Hospital of Shandong Province,Liaocheng,Shandong,252000;Department of Epidemiology and Health Statistics,School of Public Health of Suzhou Medical College of Soochow University,Suzhou,Jiangsu,215123;Center for Disease Control and Prevention of Suzhou Industrial Park of Jiangsu Province,Suzhou,Jiangsu,751599)
出处
《实用临床医药杂志》
CAS
2024年第2期1-7,12,共8页
Journal of Clinical Medicine in Practice
基金
“十三五”国家科技重大专项课题(2017ZX09304018)。
