Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou.
Guangdong Provincial Bioengineering Institute (Guangzhou Sugarcane Industry Research Institute), Guangzhou.
Eur J Neurol. 2018 Mar;25(3):577-e34. doi: 10.1111/ene.13556. Epub 2018 Jan 18.
Non-alcoholic fatty liver disease (NAFLD) is closely correlated to visceral obesity, dyslipidaemia, insulin resistance and type 2 diabetes mellitus. We sought to assess the association between a specific stroke subgroup, brainstem infarctions (BSIs) and NAFLD. Furthermore, we evaluated whether NAFLD is an independent risk factor in patients with BSIs.
Non-alcoholic fatty liver disease was assessed in 306 patients with radiologically confirmed BSIs via liver ultrasound. Differences between patients with and without NAFLD were compared. Data associated with stroke severity and progression after admission were collected.
Non-alcoholic fatty liver disease was found in 130 (42.5%) patients with acute BSIs; 58 (19.0%) had National Institutes of Health Stroke Scale scores >7 and 57 (18.6%) had progression after admission. Initial National Institutes of Health Stroke Scale scores, incidence of progression and stroke severity, and modified Rankin Scale scores at discharge were significantly higher in patients with NAFLD than in those without NAFLD. NAFLD was associated with stroke severity [Cox regression: hazard ratio (HR), 2.243; 95% confidence interval (CI), 1.254-4.013, P < 0.01]. This risk remained statistically significant after controlling for age, gender, diabetes mellitus and C-reactive protein (HR, 2.327; 95% CI, 1.252-4.324, P < 0.01). In addition, NAFLD was associated with progression (HR, 2.155; 95% CI, 1.201-3.865, P < 0.05) and remained significant after controlling for age, gender, diabetes mellitus, fibrinogen and C-reactive protein (HR, 2.378; 95% CI, 1.260-4.486, P < 0.01).
These results suggest that NAFLD is a potential risk factor when evaluating the severity and progression of acute BSIs. This relationship is independent of classic risk factors and metabolic syndrome features.
非酒精性脂肪性肝病（NAFLD）与内脏肥胖、血脂异常、胰岛素抵抗和 2 型糖尿病密切相关。本研究旨在评估特定的卒中亚组，即脑干梗死（BSI）与 NAFLD 之间的关系。此外，我们还评估了 NAFLD 是否是 BSI 患者的独立危险因素。
通过肝脏超声评估 306 例经影像学证实的 BSI 患者的 NAFLD。比较有和无 NAFLD 的患者之间的差异。收集与卒中严重程度和入院后进展相关的数据。
急性 BSI 患者中 130 例（42.5%）存在 NAFLD；58 例（19.0%）美国国立卫生研究院卒中量表（NIHSS）评分>7 分，57 例（18.6%）入院后进展。有 NAFLD 的患者初始 NIHSS 评分、进展发生率和严重程度以及出院时改良 Rankin 量表评分均显著高于无 NAFLD 的患者。NAFLD 与卒中严重程度相关（Cox 回归：风险比[HR]，2.243；95%置信区间[CI]，1.254-4.013，P<0.01）。在控制年龄、性别、糖尿病和 C 反应蛋白（HR，2.327；95%CI，1.252-4.324，P<0.01）后，这种风险仍然具有统计学意义。此外，NAFLD 与进展相关（HR，2.155；95%CI，1.201-3.865，P<0.05），在控制年龄、性别、糖尿病、纤维蛋白原和 C 反应蛋白后仍具有显著意义（HR，2.378；95%CI，1.260-4.486，P<0.01）。
这些结果表明，NAFLD 是评估急性 BSI 严重程度和进展的潜在危险因素。这种关系独立于经典危险因素和代谢综合征特征。
