Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain.
Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
Transl Stroke Res. 2019 Dec;10(6):639-649. doi: 10.1007/s12975-019-00695-x. Epub 2019 Apr 13.
It has recently emerged the concept of "obesity paradox," a term used to describe the unexpected improved prognosis and lower mortality rates found in several diseases in patients with higher body weight. Concerning stroke, few clinical studies have assessed this obesity paradox showing contradictory results. Therefore, our aim was to compare clinical evolution and inflammatory balance of obese and non-obese patients after ischemic stroke. We designed a prospective case-control study in patients with acute ischemic stroke categorized into obese (body mass index, BMI ≥ 30 kg/m) and non-obese (BMI < 30 kg/m). We compared clinical, anthropometric, radiological, and laboratory variables. The main outcome variable was the functional outcome at 3 months. We included 98 patients (48 non-obese and 50 obese). No differences in functional outcome at 3 months were found (p = 0.882) although a tendency of a greater recovery on neurological impairments was seen in obese subjects. Importantly, obese patients (p = 0.007) and patients who experienced poor outcome (p = 0.006) exhibited a higher reduction in body weight at 3 months after stroke. Moreover, pro-inflammatory IL-6 levels (p = 0.002) were higher in the obese group. However, IL-6 levels decreased over the first week in obese while increased in non-obese. On the contrary, levels of the anti-inflammatory IL-10 rose over the first week in obese patients, whereas remained stable in non-obese. In summary, despite exhibiting several factors associated with poor outcome, obese patients do not evolve worse than non-obese after ischemic stroke. Obesity may counterbalance the inflammatory reaction through an anti-inflammatory stream enhanced in the first moments of stroke.
最近出现了“肥胖悖论”的概念，该术语用于描述超重患者在几种疾病中出现的意外改善预后和降低死亡率的现象。关于中风，少数临床研究评估了这种肥胖悖论，结果显示存在矛盾。因此，我们的目的是比较肥胖和非肥胖缺血性中风患者的临床演变和炎症平衡。我们设计了一项前瞻性病例对照研究，将急性缺血性中风患者分为肥胖组（体重指数 BMI≥30kg/m）和非肥胖组（BMI<30kg/m）。我们比较了临床、人体测量学、影像学和实验室变量。主要结局变量是 3 个月时的功能结局。我们纳入了 98 名患者（48 名非肥胖和 50 名肥胖）。3 个月时的功能结局无差异（p=0.882），尽管肥胖组的神经功能缺损恢复趋势更大。重要的是，肥胖患者（p=0.007）和预后不良的患者（p=0.006）在中风后 3 个月时体重下降更多。此外，肥胖组的促炎细胞因子 IL-6 水平更高（p=0.002）。然而，肥胖组的 IL-6 水平在第一周内下降，而非肥胖组的 IL-6 水平升高。相反，肥胖患者的抗炎细胞因子 IL-10 水平在第一周内升高，而非肥胖患者的 IL-10 水平则保持稳定。总之，尽管肥胖患者表现出与不良预后相关的多种因素，但在缺血性中风后他们的病情并不比非肥胖患者差。肥胖可能通过在中风发生的最初时刻增强抗炎途径来平衡炎症反应。
