长时间久坐行为与急性缺血性脑卒中后 3 个月的长期血糖水平有关吗？一项前瞻性观察队列研究。
Is long-bout sedentary behaviour associated with long-term glucose levels 3 months after acute ischaemic stroke? A prospective observational cohort study.
机构信息
Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
出版信息
BMJ Open. 2020 Nov 26;10(11):e037475. doi: 10.1136/bmjopen-2020-037475.
BACKGROUND AND PURPOSE
Sedentary behaviour is a risk factor for vascular disease and stroke patients are more sedentary than their age-matched peers. The association with glucose levels, as a potential mediator, is unclear, and we have investigated the association between long-bout sedentary behaviour and long-term glucose levels in stroke survivors.
METHODS
This study uses data from the Norwegian Cognitive Impairment After Stroke study, a multicentre cohort study. The patients were recruited at hospital admission for acute stroke, and the follow-up was done at the outpatient clinic. Sedentary behaviour-being in a sitting or reclining position-was registered 3 months after stroke using position transition data from the body-worn sensor activPAL attached to the unaffected thigh. A MATLAB script was developed to extract activity data from 08:00 to 10:00 for 4 days and to categorise the data into four bout-length categories. The primary outcome was glycated haemoglobin (HbA1c), analysed at 3 months. Regression models were used to analyse the association between HbA1c and sedentary behaviour in the whole population and stratified based on a diagnosis of diabetes mellitus (DM). Age, body mass index and the use of antidiabetic drugs were added as covariates into the models.
RESULTS
From a total of 815 included patients, 379 patients fulfilled the inclusion criteria for this study. We found no association between time in sedentary behaviour and HbA1c in the whole stroke population. We found time in sedentary behaviour in bouts of ≥90 min to be associated with a higher HbA1c in patients with DM.
CONCLUSION
Long-bout sedentary time is associated with a higher HbA1c in patients with DM 3 months after ischaemic stroke. Future research should investigate the benefit of breaking up sedentary time as a secondary preventive measure.
TRIAL REGISTRATION NUMBER
NCT02650531, https://clinicaltrials.gov/ct2/show/NCT02650531.
背景与目的
久坐行为是血管疾病的一个危险因素，且相较于同龄人群，脑卒中患者的久坐行为更为明显。葡萄糖水平作为潜在的中介因素与久坐行为之间的关系尚不明确，因此我们调查了脑卒中幸存者的长时间久坐行为与长期葡萄糖水平之间的关系。
方法
本研究使用了挪威认知障碍后脑卒中研究的数据，这是一项多中心队列研究。患者在急性脑卒中入院时招募，在门诊进行随访。3 个月后，使用佩戴在未受影响大腿上的身体佩戴式传感器 activPAL 的位置转换数据记录脑卒中后患者的久坐行为（处于坐姿或斜躺姿势）。开发了一个 MATLAB 脚本，从 08:00 到 10:00 提取 4 天的数据，并将数据分为四个时间段长度类别。主要结局指标是糖化血红蛋白（HbA1c），在 3 个月时进行分析。回归模型用于分析整个人群中 HbA1c 与久坐行为之间的关系，并根据糖尿病（DM）的诊断进行分层。将年龄、体重指数和抗糖尿病药物的使用情况作为协变量添加到模型中。
结果
在总共纳入的 815 名患者中，有 379 名患者符合本研究的纳入标准。我们发现，整个脑卒中人群中久坐行为时间与 HbA1c 之间没有关联。我们发现，DM 患者中久坐行为持续时间≥90 分钟与 HbA1c 升高有关。
结论
缺血性脑卒中后 3 个月，长时间久坐与 DM 患者的 HbA1c 升高有关。未来的研究应调查打破久坐时间作为二级预防措施的获益。
试验注册号
NCT02650531，https://clinicaltrials.gov/ct2/show/NCT02650531。
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