中青年体质指数、腰围及腰臀比与脑卒中发生的相关性研究

摘要

目的 探讨中青年人肥胖的不同指标,如体质指数(BMI)、腰围(WC)及腰臀比(WHR)与脑卒中发生的关系.方法 采用以医院为基础的病例对照研究.病例组由280例脑卒中(缺血性脑卒中和出血性脑卒中)患者组成,对照组为患其他与脑卒中无关的疾病同期入住和病例组相同医院的280例患者.采用标准调查表对研究对象进行调查,收集研究对象的人口学特征、生活方式、个体疾病史、脑卒中家族遗传史以及实验室检查等资料,同时对身高、体质量、WC、臀围进行测量,并计算BMI及WHR.采用多元Logistic回归分析对研究对象的BMI、WC及WHR与脑卒中的比值比(OR)及其95%可信区间(CI)进行估计.结果 280例脑卒中患者中出血性76例,缺血性204例.与正常BMI者相比较,调整年龄、性别后的分析结果显示,超重或肥胖的病例发生缺血性脑卒中的危险性明显高于对照组[超重者:OR=2.03,95%CI(1.26,2.91),P＜0.05;肥胖者:OR=1.88,95%CI(1.32,2.39),P＜0.05].与BMI最低四分位数相比,BMI最高四分位数的病例发生缺血性脑卒中的危险性增加了18%[OR=1.18,95% CI(1.06,3.54),P＜0.01].WC最高四分位数的病例发生出血性和缺血性脑卒中的危险性分别是WC最低四分位数的1.80和1.96倍[OR =1.80,95%CI(1.03,3.16)和OR =1.96,95%CI(1.37,3.78),P＜0.01].与WHR最低四分位数比较,WHR最高四分位数的病例发生出血性及缺血性脑卒中的危险性分别增加了98%和126%[OR=1.98,95%CI(1.41,3.59),P＜0.01和OR=2.26,95%CI(1.34,2.79),P＜0.01].结论 BMI增高是发生脑卒中的一个重要危险因素,WC增加可使发生缺血性脑卒中的危险性显著升高,而WHR与发生出血性及缺血性脑卒中的危险性呈正相关.维持正常体质量可能是脑卒中发病的保护因素.%Objective To explore the association between adiposity indicators including body mass index ( BMI ), waist circumference ( WC ), and waist - hip ratio ( WHR ) and the risk of stroke in young and middle - aged individuals. Methods In this hospital - based case - control study, 280 patients with stroke were enrolled as case group and 280 otherwise healthy patients admitted to the same hospital during the same period as the control group. All subjects were interviewed using a structure-d interviewer - administrated questionnaire that included information on socio - demographic characteristics, lifestyle habits, an-thropometric measures, personal medical history, and family history of stroke in first - degree relatives, and laboratory examinations. Height, weight, and waist and hip circumferences were measured using unified standards by professionally trained investigators , and simultaneously BMI and WHR were calculated. The odds ratios ( OR ) and 95 % confidence intervals ( CI ) of total and type - specific stroke were estimated using multiple logistic regression models. Results Totally 280 patients with stroke were involved in the study ( 76 hemorrhagic and 204 ischemic ). Compared to the controls with normal BMI, after age and gender - adjusted, overweight and obesity were associated with a significantly increased risk of ischemic stroke [ among overweight: OR = 2.03, 95% CI (1.26, 2.91), P <0. 05; among obesity: OR = 1.88, 95% CI (1.32, 2.39), P<0.05]. Compared to controls in the lowest quartile, the cases in the highest quartile of BMI were also associated with increased risk of ischemic stroke [ OR = 1. 18, 95%CI ( 1.06, 3.54), P<0.01 ]. Cases in the highest quartile of BMI had 1.80 and 1.96 times the risk of hemorrhagic and ischemic stroke as did those controls in the lowest quartile [ OR = 1. 80, 95% CI ( 1. 03, 3. 16 ) and OR = 1. 96, 95% CI ( 1. 37, 3. 78 ), P <0. 01 ]. Further multivariate logistic regression models were constructed. Cases in the highest quartile of WHR had approximately 1. 98 and 2. 26 times the risk of hemorrhagic and ischemic stroke as controls in the lowest quartile [ OR = 1. 98, 95% CI ( 1. 41, 3. 59 ) and OR = 2. 26, 95% CI ( 1. 34, 2. 79 ), P < 0. 01 ]. Conclusion Higher BMI is an important risk factor for stroke, and higher WC is associated with an increased risk of ischemic stroke. WHR is positively corelated to hemorrhagic and ischemic stroke.