肝纤维化的Fibrosis-4指数升高与出血性中风风险之间的关联。
Association between elevated fibrosis-4 index of liver fibrosis and risk of hemorrhagic stroke.
作者信息
Parikh Neal S, Zhang Cenai, Bruce Samuel S, Murthy Santosh B, Rosenblatt Russell, Liberman Ava L, Liao Vanessa, Kaiser Jed H, Navi Babak B, Iadecola Costantino, Kamel Hooman
机构信息
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
出版信息
Eur Stroke J. 2025 Mar;10(1):289-297. doi: 10.1177/23969873241259561. Epub 2024 Jun 13.
BACKGROUND
Cirrhosis is associated with an increased risk of hemorrhagic stroke. Liver fibrosis, typically a silent condition, is antecedent to cirrhosis. The objective of this study was to test the hypothesis that elevated Fibrosis-4 (FIB-4) index, indicating a high probability of liver fibrosis, is associated with an increased risk of hemorrhagic stroke.
METHODS
We performed a cohort analysis of the prospective United Kingdom Biobank cohort study. Participants 40-69 years old were enrolled between 2007 and 2010 and had available follow-up data until March 1, 2018. We excluded participants with prevalent hemorrhagic stroke or thrombocytopenia. High probability of liver fibrosis was defined as having a value >2.67 of the validated FIB-4 index. The primary outcome was hemorrhagic stroke (intracerebral or subarachnoid hemorrhage), defined based on hospitalization and death registry data. Secondary outcomes were intracerebral and subarachnoid hemorrhage, separately. We used Cox proportional hazards models to evaluate the association of FIB-4 index >2.67 with hemorrhagic stroke while adjusting for potential confounders including hypertension, alcohol use, and antithrombotic use.
RESULTS
Among 452,994 participants (mean age, 57 years; 54% women), approximately 2% had FIB-4 index >2.67, and 1241 developed hemorrhagic stroke. In adjusted models, FIB-4 index >2.67 was associated with an increased risk of hemorrhagic stroke (HR, 2.0; 95% CI, 1.6-2.6). Results were similar for intracerebral hemorrhage (HR, 2.0; 95% CI, 1.5-2.7) and subarachnoid hemorrhage (HR, 2.2; 95% CI, 1.5-3.5) individually.
CONCLUSIONS
Elevated FIB-4 index was associated with an increased risk of hemorrhagic stroke.
背景
肝硬化与出血性中风风险增加相关。肝纤维化通常是一种无症状的病症，是肝硬化的前驱病变。本研究的目的是检验以下假设：纤维化-4（FIB-4）指数升高表明肝纤维化可能性高，与出血性中风风险增加相关。
方法
我们对前瞻性英国生物银行队列研究进行了队列分析。年龄在40 - 69岁之间的参与者于2007年至2010年入组，并拥有截至2018年3月1日的有效随访数据。我们排除了患有出血性中风或血小板减少症的参与者。肝纤维化高可能性定义为经验证的FIB-4指数值>2.67。主要结局是出血性中风（脑出血或蛛网膜下腔出血），根据住院和死亡登记数据定义。次要结局分别是脑出血和蛛网膜下腔出血。我们使用Cox比例风险模型评估FIB-4指数>2.67与出血性中风的关联，同时调整包括高血压、饮酒和抗血栓药物使用等潜在混杂因素。
结果
在452,994名参与者（平均年龄57岁；54%为女性）中，约2%的人FIB-4指数>2.67，1241人发生了出血性中风。在调整模型中，FIB-4指数>2.67与出血性中风风险增加相关（风险比[HR]，2.0；95%置信区间[CI]，1.6 - 2.6）。脑出血（HR，2.0；95% CI，1.5 - 2.7）和蛛网膜下腔出血（HR，2.2；95% CI，1.5 - 3.5）各自的结果相似。
结论
FIB-4指数升高与出血性中风风险增加相关。
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