Lioutas Vasileios-Arsenios, Beiser Alexa, Himali Jayandra, Aparicio Hugo, Romero Jose Rafael, DeCarli Charles, Seshadri Sudha
From the Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (V.-A.L.); Department of Biostatistics (A.B., J.H.) and Department of Neurology (A.B., J.H., H.A., J.R.R., S.S.), Boston University School of Medicine, MA; Department of Neurology, University of California Davis (C.D.); and Framingham Heart Study, MA (V.-A.L., A.B., J.H., H.A., J.R.R., S.S.).
Stroke. 2017 Feb;48(2):486-489. doi: 10.1161/STROKEAHA.116.014839. Epub 2016 Dec 22.
Lacunar stroke (LS) and intracerebral hemorrhage (ICH) are 2 diverse manifestations of small vessel disease. What predisposes some patients to ischemic stroke and others to hemorrhage is not well understood.
We performed a nested case-control study within the FHS (Framingham Heart Study) comparing people with incident ICH and lacunar ischemic stroke, to age- and sex-matched controls for baseline prevalence and levels of cardiovascular risk factors.
We identified 118 LS (mean age 74 years, 51% male) and 108 ICH (75 years, 46% male) events. Hypertension, diabetes mellitus, smoking, and obesity were strongly associated with LS. Hypertension, but not diabetes mellitus, smoking, or cholesterol levels increased the odds of ICH. Contrary to LS, ICH cases had lower body mass index (BMI) than their controls (26 versus 27); BMI <20 was associated with 4-fold higher odds for ICH. In direct comparison, LS cases had higher BMI (28 versus 26) and obesity prevalence (odds ratio, 3.1); BMI <20 was associated with significantly lower odds of LS (odds ratio, 0.1).
LS and ICH share hypertension, but not diabetes mellitus, as a common risk factor. ICH cases had lower BMI compared with not only LS but their controls as well; this finding is unexplained and merits further exploration.
腔隙性卒中（LS）和脑出血（ICH）是小血管疾病的两种不同表现形式。目前尚不清楚为何有些患者易患缺血性卒中，而另一些患者易患出血性卒中。
我们在弗雷明汉心脏研究（FHS）中进行了一项巢式病例对照研究，比较了发生ICH和腔隙性缺血性卒中的患者与年龄和性别匹配的对照者的心血管危险因素的基线患病率和水平。
我们确定了118例LS事件（平均年龄74岁，男性占51%）和108例ICH事件（75岁，男性占46%）。高血压、糖尿病、吸烟和肥胖与LS密切相关。高血压会增加ICH的发病几率，但糖尿病、吸烟或胆固醇水平则不会。与LS相反，ICH患者的体重指数（BMI）低于其对照者（分别为26和27）；BMI<20与ICH发病几率高出4倍相关。直接比较发现，LS患者的BMI较高（分别为28和26）且肥胖患病率较高（比值比为3.1）；BMI<20与LS发病几率显著降低相关（比值比为0.1）。
LS和ICH都有高血压这一共同危险因素，但糖尿病并非如此。与LS及其对照者相比，ICH患者的BMI较低；这一发现尚无合理解释，值得进一步探究。
