Abstract:

Objective  To 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.  Methods  A 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. Results  BMI 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/m² subgroup was significantly higher than that in BMI < 18.50 kg/m² subgroup (Z = 4.823, P = 0.028), 18.50-23.90 kg/m² subgroup (Z = 3.157, P = 0.026) and ≥ 28 kg/m² subgroup (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/m2 subgroup was significantly higher than that in < 18.50 kg/m² subgroup (Z = 9.263, P = 0.020), 18.50-23.90 kg/m² subgroup (Z = 18.780, P = 0.000) and 24.00-27.90 kg/m2 subgroup (Z = 6.817, P = 0.009). SAO ratio in BMI 18.50-23.90 kg/m² subgroup was significantly higher than that in < 18.50 kg/m² subgroup (Z = 7.404, P = 0.007), 24.00-27.90 kg/m² subgroup (Z = 22.849, P = 0.000) and ≥ 28 kg/m² subgroup (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.  Conclusions  BMI and AGI can influence the location and etiology of ischemic stroke, which can be used to predict the etiology and pathogenesis of ischemic stroke.

Key words: Stroke, Brain ischemia, Body weight, Abdomen, Anthropometry

摘要：

目的 探讨体重指数（BMI）和腹围指数（AGI）对缺血性卒中部位和病因的影响，以判断二者能否预测缺血性卒中病因和发病机制。方法 共185 例急性缺血性卒中患者和性别、年龄、既往史相匹配的155 例正常对照者，测量身高和体重并计算体重指数，测量腹围并计算腹围指数，进行英国牛津郡社区脑卒中项目（OCSP）分型和TOAST 分型。结果 缺血性卒中患者超重（BMI 24.00 ~ 27.90 kg/m²）亚组（t = 2.060，P = 0.000）和肥胖（BMI ≥ 28 kg/m²）亚组（t = 2.315，P = 0.000）体重指数均高于正常对照者，腹围异常（AGI＞1 cm/kg）亚组腹围指数高于正常对照者（t = 1.021，P = 0.000）。185 例急性缺血性卒中患者据OCSP 分型分为完全前循环梗死型（TACI 型）10 例（5.41%）、部分前循环梗死型（PACI 型）81 例（43.78%）、腔隙性梗死型（LACI型）56例（30.27%）和后循环梗死型（POCI型）38例（20.54%）；不同体重指数患者仅PACI 型比例差异有统计学意义（H = 7.041，P = 0.011），24.00 ~ 27.90 kg/m² 亚组PACI 型比例高于< 18.50 kg/m² 亚组（Z = 4.823，P = 0.028）、18.50 ~ 23.90 kg/m² 亚组（Z = 3.157，P = 0.026）和≥ 28 kg/m² 亚组（Z = 2.076，P = 0.015）；不同腹围指数患者仅POCI 型比例> 1 cm/kg 亚组高于≤ 1 cm/kg 亚组（χ² = 6.624，P = 0.010）。据TOAST 分型分为大动脉粥样硬化型（LAA 型）59 例（31.89%）、小动脉闭塞型（SAO型）57 例（30.81%）、心源性栓塞型（CE 型）32 例（17.30%）、其他明确病因型（SOE 型）17 例（9.19%）和不明病因型（SUE 型）20 例（10.81%）；不同体重指数患者LAA 型（H = 21.597，P = 0.000）和SAO 型（H = 29.908，P = 0.000）比例差异具有统计学意义，其中，≥ 28 kg/m² 亚组LAA 型比例高于< 18.50 kg/m² 亚组（Z = 9.263，P = 0.020）、18.50 ~ 23.90 kg/m² 亚组（Z = 18.780，P = 0.000）和24.00 ~ 27.90 kg/m² 亚组（Z = 6.817，P = 0.009），18.50 ~ 23.90 kg/m² 亚组SAO 型比例高于< 18.50 kg/m² 亚组（Z = 7.404，P = 0.007）、24.00 ~ 27.90 kg/m² 亚组（Z = 22.849，P = 0.000）以及≥ 28 kg/m² 亚组（Z = 12.025，P = 0.001）；不同腹围指数患者> 1 cm/kg 亚组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 亚组。结论 体重指数和腹围指数均可以影响缺血性卒中部位和病因，可以用于预测缺血性卒中病因和发病机制。

关键词: 卒中, 脑缺血, 体重, 腹部, 人体测量术