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目的评估老年肥胖群体与脑微出血(CMBs)的相关性,进而探讨可能的影响机制。方法采用病历分组法,持续纳入例行健康检查且神经系统无症状的老年受试者(386例,年龄≥65岁)进行研究。脑微出血通过T2加权梯度回波MRI进行评价。受试者按照CMBs的位置被分为两组:完全脑叶性微出血和深部或幕下微出血。肥胖的定义采用世界卫生组织西太平洋区域的官方标准。分析年龄、血糖水平、胆固醇水平、高密度脂蛋白胆固醇(HDL-C)水平和甘油三酯水平、性别、糖尿病、高脂血症、冠状动脉疾病、阿司匹林或华法林使用和吸烟的比例等变量与CMBs的关系,同时分析肥胖程度与CMBs的相关性。结果共有37名(9.6%)受试者被发现有CMBs。随肥胖的严重程度增加,CMBs发病率将会增加,差异有统计学意义(P<0.05)。控制可能的混杂因素后,与体重正常组相比,在超重组[OR=2.32,95%CI:1.19~4.53]和肥胖组(OR=2.17,95%CI:1.14~4.13),深部或幕下微出血的风险显著升高,差异有统计学意义(P<0.05)。然而无论是在超重或肥胖组,完全脑叶性微出血的ORs均未增加,差异无统计学意义(P>0.05)。此外,肥胖与深部或幕下微出血有关,差异有统计学意义(P<0.05)。结论肥胖者通过动脉硬化血管病变影响脑微血管。在老年群体中,肥胖与亚临床型和出血倾向的脑血管疾病很可能具有相关性。
Objective To evaluate the relationship between obesity and cerebral micro-hemorrhage (CMBs) in elderly people and to explore the possible mechanism. Methods The study was divided into two groups according to medical record grouping method: elderly subjects (386 cases, ≥65 years old) who were continuously included in routine health examination and whose neurological symptoms were asymptomatic. Cerebral microbleeds were evaluated by T2-weighted gradient echo MRI. Subjects were divided into two groups according to the location of CMBs: complete lobar hemorrhage and deep or submucosal hemorrhage. The definition of obesity uses the official WHO standard for the Western Pacific Region. Analysis of age, blood glucose level, cholesterol level, HDL-C level and triglyceride level, sex, diabetes, hyperlipidemia, coronary artery disease, aspirin or warfarin use and smoking ratio Variables and CMBs, and analyze the correlation between the degree of obesity and CMBs. Results A total of 37 (9.6%) subjects were found to have CMBs. With the increase of the severity of obesity, the incidence of CMBs will increase, the difference is statistically significant (P <0.05). After controlling for possible confounders, patients in the overweight group [OR = 2.32, 95% CI: 1.19-4.53] and obesity group (OR = 2.17, 95% CI: 1.14-4.13) The risk of micro-bleeding was significantly increased, the difference was statistically significant (P <0.05). However, there was no significant difference in the ORs of complete lobar hemorrhage whether in overweight or obese group (P> 0.05). In addition, obesity and submucosal bleeding or bleeding, the difference was statistically significant (P <0.05). Conclusion Obesity affects cerebral capillaries through atherosclerotic vascular lesions. In the elderly, it is likely that obesity is associated with subclinical and bleeding-prone cerebrovascular disease.