Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK.
Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK; Brighton and Sussex Medical School, University of Sussex, East Sussex, UK.
J Stroke Cerebrovasc Dis. 2023 Apr;32(4):106979. doi: 10.1016/j.jstrokecerebrovasdis.2023.106979. Epub 2023 Jan 20.
Sarcopenia is associated with poor outcomes, and evidence suggests an inverse relationship between skeletal muscle mass and cardiovascular risk. Sarcopenia has been studied after stroke, but its value as a risk factor for stroke has not been examined. This prospective cohort study measured sarcopenia in stroke/TIA patients at baseline to explore its role in predicting recurrent events.
The Arterial Stiffness In lacunar Stroke and TIA (ASIST) study included 96 patients with TIA/lacunar stroke, of which 82 patients (mean age 71.2±10.8 years) had bioimpedance analysis to assess body composition. Skeletal Mass Index (SMI) was calculated and parameters of sarcopenia assessed using Davison (1) and Janssen (2) criteria. Recurrent cerebrovascular events were monitored over 5 years.
Eighteen patients had recurrent events. On independent samples t test there were significantly more participants with sarcopenia in the recurrent events group (89% vs 56%, p<0.001) using Davison (1) criteria, as well as lower mean SMI, significantly more participants with diabetes and higher arterial stiffness. On binary logistic regression, the only significant predictors of recurrent events were SMI (p=0.036, hazard ratio=0.414, 95% confidence interval 0.195-0.948) and diabetes (p=0.004, hazard ratio=9.06, 95% confidence interval 2.009-40.860) when corrected for age, sex and cardiovascular risk factors. Using Janssen (2) criteria in the regression, severe sarcopenia was a significant predictor of recurrent events (p=0.028). There was a significant association between sarcopenia and recurrent events on Chi square based on Davison (p=0.02) and Janssen (p=0.034) definitions.
The presence of baseline sarcopenia in stroke and TIA patients is an independent predictor of recurrent events.
肌少症与不良结局相关，有证据表明骨骼肌量与心血管风险呈负相关。肌少症已在中风后进行了研究，但它作为中风风险因素的价值尚未得到检验。本前瞻性队列研究在基线时测量了中风/TIA 患者的肌少症，以探讨其在预测复发事件中的作用。
动脉僵硬度在腔隙性卒中和 TIA 中的研究（ASIST）纳入了 96 例 TIA/腔隙性卒中患者，其中 82 例患者（平均年龄 71.2±10.8 岁）接受生物电阻抗分析评估身体成分。计算骨骼肌指数（SMI），并使用 Davison（1）和 Janssen（2）标准评估肌少症的参数。在 5 年内监测复发性脑血管事件。
18 例患者发生了复发性事件。在独立样本 t 检验中，使用 Davison（1）标准，复发事件组中肌少症患者明显更多（89%比 56%，p<0.001），且平均 SMI 更低，糖尿病患者更多，动脉僵硬程度更高。在二项逻辑回归中，复发性事件的唯一显著预测因素是 SMI（p=0.036，危险比=0.414，95%置信区间 0.195-0.948）和糖尿病（p=0.004，危险比=9.06，95%置信区间 2.009-40.860），校正年龄、性别和心血管危险因素后。在回归中使用 Janssen（2）标准，严重肌少症是复发性事件的显著预测因素（p=0.028）。基于 Davison（p=0.02）和 Janssen（p=0.034）标准的卡方检验显示，肌少症与复发性事件之间存在显著关联。
中风和 TIA 患者的基线肌少症存在是复发性事件的独立预测因素。
