From the Department of Neurosurgery (S.R.P., A.C.L., N.S.D., X.Z., J.M., C.P.K.), Mount Sinai Hospital, New York.
Department of Medicine, Division of General Internal Medicine (E.D.), Mount Sinai Hospital, New York.
Stroke. 2019 Apr;50(4):999-1002. doi: 10.1161/STROKEAHA.119.024638.
Background and Purpose- Although obesity is an established risk factor for cardiovascular disease and stroke, studies have shown evidence of an obesity paradox-a protective effect of obesity in patients who already have these disease states. Data on the obesity paradox in intracerebral hemorrhage is limited. Methods- Clinical data for adult intracerebral hemorrhage patients were extracted from the National Inpatient Sample between 2007 and 2014. Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality, discharge disposition, length of stay, tracheostomy or gastrostomy placement, and ventriculoperitoneal shunt placement. Results- There were 99 212 patients who were eligible. Patients with both obesity (OR=0.69; 95% CI=0.62-0.76; P<0.001) and morbid obesity (OR=0.85; 95% CI=0.74-0.97; P=0.02) were associated with decreased odds of in-hospital mortality. Morbid obesity was significantly associated with increased odds of a tracheostomy or gastrostomy placement (OR=1.42; 1.20-1.69; P<0.001) and decreased odds of a routine discharge disposition (OR=0.84; 0.74-0.97; P=0.014). Conclusions- Obesity and morbid obesity appear to protect against mortality in intracerebral hemorrhage.
背景与目的-尽管肥胖是心血管疾病和中风的既定危险因素，但已有研究表明存在肥胖悖论-即肥胖对已有这些疾病状态的患者具有保护作用。关于脑出血中肥胖悖论的数据有限。方法-从 2007 年至 2014 年，从国家住院患者样本中提取了成人脑出血患者的临床数据。多变量逻辑回归分析了体型与住院死亡率、出院去向、住院时间、气管造口术或胃造口术以及脑室-腹腔分流术之间的关联。结果-共有 99212 名符合条件的患者。肥胖（OR=0.69；95%CI=0.62-0.76；P<0.001）和病态肥胖（OR=0.85；95%CI=0.74-0.97；P=0.02）患者的住院死亡率降低的可能性降低。病态肥胖与气管造口术或胃造口术（OR=1.42；1.20-1.69；P<0.001）的发生几率增加以及常规出院去向（OR=0.84；0.74-0.97；P=0.014）的发生几率降低显著相关。结论-肥胖和病态肥胖似乎可降低脑出血患者的死亡率。
