Chen Keyang, Pan Yuesong, Xiang Xianglong, Meng Xia, Yao Dongxiao, Lin Li, Li Xiaokun, Wang Yongjun
Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Research Units of Clinical Translation of Cell Growth Factors and Diseases Research, Chinese Academy of Medical Science, Wenzhou Medical University, Wenzhou, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
Comput Biol Med. 2023 May;157:106692. doi: 10.1016/j.compbiomed.2023.106692. Epub 2023 Feb 28.
Few researches have looked at the relationship between nonalcoholic fatty liver disease (NAFLD) at the time of admission and the long-term outcomes of patients suffering from acute ischemic stroke (AIS). We aimed to probe the relationship between NAFLD risk evaluated by NAFLD indices and long-term endpoints, along with the prognostic value of merging NAFLD indices with established risk markers for the prognosis of AIS patients. The fatty liver index (FLI) and the Hepatic steatosis index (HSI) were used to evaluate NAFLD risk in the Third China National Stroke Registry (CNSR-III), a large, prospective, national, multicenter cohort registry study. NAFLD was defined as FLI ≥35 for males and FLI ≥ 20 for females, as well as HSI>36. Death or major disability (modified Rankin Scale score ≥3) were the primary outcomes following the beginning of a stroke. On patient outcomes, the prognostic performance of two objective NAFLD parameters was evaluated. NAFLD was detected in 32.10-51.90% of AIS patients. After 1-year, 14.5% of the participants had died or suffered a severe outcome. After controlling for known risk factors, NAFLD was associated with a modest probability of adverse outcome (odds ratio,0.72[95% CI, 0.61-0.86] for FLI; odds ratio,0.68[95% CI, 0.55-0.85] for HSI). The inclusion of the two NAFLD indicators in the conventional prediction model was justified by the integrated discrimination index, continuing to increase the model's overall predictive value for long-term adverse outcomes. NAFLD risk was linked to a lower risk of long-term death or major disability in people with AIS. The predictive value of objective NAFLD after AIS was demonstrated in our study.
很少有研究关注急性缺血性卒中（AIS）患者入院时的非酒精性脂肪性肝病（NAFLD）与长期预后之间的关系。我们旨在探究通过NAFLD指数评估的NAFLD风险与长期终点之间的关系，以及将NAFLD指数与已确立的AIS患者预后风险标志物相结合的预后价值。在中国国家卒中登记研究（CNSR-III）中，使用脂肪肝指数（FLI）和肝脂肪变性指数（HSI）评估NAFLD风险，这是一项大型、前瞻性、全国性、多中心队列登记研究。NAFLD的定义为男性FLI≥35，女性FLI≥20，以及HSI>36。卒中发作后的主要结局为死亡或严重残疾（改良Rankin量表评分≥3）。关于患者结局，评估了两个客观NAFLD参数的预后性能。在32.10%-51.90%的AIS患者中检测到NAFLD。1年后，14.5%的参与者死亡或出现严重结局。在控制已知风险因素后，NAFLD与不良结局的适度概率相关（FLI的比值比为0.72[95%CI，0.61-0.86]；HSI的比值比为0.68[95%CI，0.55-0.85]）。综合判别指数证明将这两个NAFLD指标纳入传统预测模型是合理的，该指数继续提高了模型对长期不良结局的总体预测价值。NAFLD风险与AIS患者长期死亡或严重残疾的较低风险相关。我们的研究证明了AIS后客观NAFLD的预测价值。
