Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
Eur J Neurol. 2020 Aug;27(8):1672-1679. doi: 10.1111/ene.14304. Epub 2020 May 30.
The objective of this study was to investigate the association between body mass index (BMI) and both initial stroke severity at presentation and functional outcomes after acute ischaemic stroke (AIS) in patients with non-valvular atrial fibrillation (NVAF).
Patients were categorized on the basis of their BMI into underweight (BMI <18.5, n = 111), normal (18.5 ≤ BMI <25, n = 1036) and overweight to obese (BMI ≥25, n = 472) groups. Initial stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score and functional outcomes were assessed using the modified Rankin Scale score at discharge. The differences in stroke severity and functional outcomes were compared between groups using robust log-linear regression with a Poisson distribution and binary logistic regression analysis.
A total of 1619 AIS patients with NVAF from six hospitals were included. Compared with the NIHSS scores [median 5, interquartile range (IQR) 2-14] of normal-weight patients, the NIHSS scores (median 9, IQR 4-19) of underweight patients were more likely to be higher, whereas those of overweight to obese patients were lower (median 4, IQR 1-12) (P < 0.001). In terms of functional outcomes after stroke, underweight patients had a higher risk of poor functional outcomes (odds ratio 1.78, 95% confidence interval 1.09-2.56, P = 0.01) but overweight to obese patients had no significant difference in functional outcomes compared with normal-weight patients.
An inverse association was found between BMI and stroke severity in AIS patients with NVAF. This suggests the presence of an obesity paradox for short-term outcomes in patients with NVAF.
本研究旨在探讨非瓣膜性心房颤动（NVAF）患者的体重指数（BMI）与发病时初始卒中严重程度和急性缺血性卒中（AIS）后功能结局的相关性。
根据 BMI 将患者分为消瘦组（BMI<18.5，n=111）、正常体重组（18.5≤BMI<25，n=1036）和超重至肥胖组（BMI≥25，n=472）。采用国立卫生研究院卒中量表（NIHSS）评分评估初始卒中严重程度，采用改良 Rankin 量表评分评估出院时的功能结局。采用稳健对数线性回归泊松分布和二项逻辑回归分析比较组间卒中严重程度和功能结局的差异。
共纳入来自 6 家医院的 1619 例 NVAF 患者。与正常体重组的 NIHSS 评分（中位数 5，四分位距[IQR] 2-14）相比，消瘦组的 NIHSS 评分（中位数 9，IQR 4-19）更有可能较高，而超重至肥胖组的 NIHSS 评分较低（中位数 4，IQR 1-12）（P<0.001）。在卒中后的功能结局方面，消瘦患者发生不良功能结局的风险较高（比值比 1.78，95%置信区间 1.09-2.56，P=0.01），但超重至肥胖患者与正常体重患者的功能结局无显著差异。
在 NVAF 的 AIS 患者中，BMI 与卒中严重程度呈负相关。这表明在 NVAF 患者中存在短期预后的肥胖悖论。
