Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Depart-ment of Neurology, Mayo Clinic, Ro-chester, Minnesota.
Neurosurgery. 2019 May 1;84(5):1035-1042. doi: 10.1093/neuros/nyy104.
Increased body mass index (BMI) may be protective against cerebral ischemia in certain clinical contexts.
To investigate whether increased BMI was associated with delayed cerebral ischemia (DCI) and subsequent infarction after aneurysmal subarachnoid hemorrhage (aSAH).
We retrospectively reviewed the clinical course of patients presenting to our institution for management of aSAH. Patient were segregated according to BMI< or ≥29.4, a value determined by Classification and Regression Tree analysis. Predictors of DCI and delayed infarction were identified using stepwise multivariate logistic regression analysis.
There were 161 patients included for analysis. Average BMI within our patient cohort was 28.9, with 67 patients presenting with a BMI of ≥29.4 on admission. DCI occurred in 50 patients (31.1%) and was complicated by delayed infarction in 15 patients (9.3%). On stepwise multivariate analysis, BMI ≥ 29.4 was independently associated with reduced likelihood of DCI (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.92) and delayed infarction (OR 0.13, 95% CI 0.02-0.61; P = .008). Increasing maximum flow velocity on transcranial Doppler ultrasound was independently associated with increased odds of both DCI (Unit OR 1.19, 95% CI 1.09-1.30; P < .001) and delayed infarction (Unit OR 1.31, 95% CI 1.13-1.56; P < .001), while intracerebral hemorrhage was independently associated with increased odds of delayed infarction (OR 6.99, 95% CI 1.82-30.25; P = .005).
We report an association between elevated BMI and reduced incidence of DCI and delayed infarction, suggesting a protective effect of increasing BMI on the risk of ischemic complications after aSAH.
在某些临床情况下，较高的体重指数（BMI）可能对脑缺血具有保护作用。
研究较高的 BMI 是否与动脉瘤性蛛网膜下腔出血（aSAH）后的迟发性脑缺血（DCI）和随后的梗死有关。
我们回顾性地分析了就诊于我院接受 aSAH 治疗的患者的临床病程。根据 BMI＜或≥29.4 对患者进行分组，29.4 这个值是通过分类回归树分析确定的。采用逐步多元逻辑回归分析来确定 DCI 和迟发性梗死的预测因素。
共有 161 例患者纳入分析。我们的患者队列中平均 BMI 为 28.9，入院时 BMI≥29.4 的患者有 67 例。50 例患者发生 DCI（31.1%），其中 15 例发生迟发性梗死（9.3%）。逐步多元分析显示，BMI≥29.4 与 DCI（比值比 [OR] 0.42，95%置信区间 [CI] 0.18-0.92）和迟发性梗死（OR 0.13，95%CI 0.02-0.61；P=0.008）的可能性降低相关。经颅多普勒超声检查中最大血流速度的增加与 DCI（单位 OR 1.19，95%CI 1.09-1.30；P＜0.001）和迟发性梗死（单位 OR 1.31，95%CI 1.13-1.56；P＜0.001）的可能性增加相关，而脑出血与迟发性梗死（OR 6.99，95%CI 1.82-30.25；P=0.005）的可能性增加相关。
我们报告了 BMI 升高与 DCI 和迟发性梗死发生率降低之间的关联，表明较高的 BMI 对 aSAH 后缺血性并发症的风险具有保护作用。
