Mercier Hannah W, Solinsky Ryan, Taylor J Andrew
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA.
J Spinal Cord Med. 2024 May;47(3):379-386. doi: 10.1080/10790268.2022.2065410. Epub 2022 Apr 29.
CONTEXT/OBJECTIVES: Cardiometabolic disease (CMD) is increased after spinal cord injury (SCI), with an increased number of CMD risk factors that relate to higher mortality. The study objective was to characterize the relationship of age and injury duration with CMD.
Retrospective cohort assessment of CMD risks using unbiased recursive partitioning to divide for group comparison: (1) Lowest Risk, (2) Moderate Risk, and (3) Highest Risk based on classification and regression trees predicting CMD diagnosis by age and injury duration.
Academic rehabilitation center laboratory.
Adults ( = 103; aged 18-75) with traumatic SCI (C4-L2) of 3 months to 42 years duration.
NA.
CMD risk factors (obesity, insulin resistance, dyslipidemia, and hypertension) using Paralyzed Veterans of America SCI-specific guidelines.
Obesity was prevalent (82%) and co-occurred with most other risk factors present. Age increased odds for CMD diagnosis by 1.05 per year ( = 0.02) and was directly related to elevated body mass index (BMI, β = 0.42, < 0.05), fasting glucose (β = 0.58, < 0.01), and higher systolic blood pressure (β = 0.31, < 0.10). In contrast, time since injury contributed to lower risk factor count (β = -0.29, < 0.10) and higher HDL-C (β = 0.50, < 0.01), and was not related to odds of CMD diagnosis.
While SCI is linked to an increased risk of CMD, age is associated with higher CMD risk. Increased SCI duration related to improvement in individual CMD risk factors but did not decrease overall risk for CMD diagnosis. SCI may not uniformly increase CMD risks and highlight a necessary focus on weight management for risk prevention.
背景/目的：脊髓损伤（SCI）后心脏代谢疾病（CMD）风险增加，CMD风险因素数量增多，且与更高的死亡率相关。本研究目的是描述年龄和损伤持续时间与CMD之间的关系。
采用无偏递归划分对CMD风险进行回顾性队列评估，以便进行组间比较：（1）低风险组，（2）中度风险组和（3）高风险组，划分依据是通过年龄和损伤持续时间预测CMD诊断的分类回归树。
学术康复中心实验室。
103名成人（年龄18 - 75岁），创伤性SCI（C4 - L2），损伤持续时间为3个月至42年。
无。
采用美国退伍军人瘫痪者SCI专用指南评估CMD风险因素（肥胖、胰岛素抵抗、血脂异常和高血压）。
肥胖很常见（82%），且与大多数其他风险因素同时出现。年龄每增加1岁，CMD诊断的几率增加1.05（P = 0.02），且与体重指数升高（BMI，β = 0.42，P < 0.05）、空腹血糖升高（β = 0.58，P < 0.01）以及收缩压升高（β = 0.31，P < 0.10）直接相关。相比之下，受伤后的时间与风险因素数量减少（β = -0.29，P < 0.10）和高密度脂蛋白胆固醇升高（β = 0.50，P < 0.01）有关，与CMD诊断几率无关。
虽然SCI与CMD风险增加有关，但年龄与更高的CMD风险相关。SCI持续时间增加与个体CMD风险因素的改善有关，但并未降低CMD诊断的总体风险。SCI可能不会一致地增加CMD风险，并突出了预防风险时体重管理的必要性。
