不同肥胖代谢表型与大动脉粥样硬化型和小动脉闭塞型急性脑梗死的关联性研究

doi:10.3969/j.issn.1673-5765.2026.02.008

摘要/Abstract

摘要： 目的探讨不同肥胖代谢表型与大动脉粥样硬化（large-artery atherosclerosis，LAA）型及小动脉闭塞（small-artery occlusion，SAO）型急性脑梗死（acute cerebral infarction，ACI）的关联。
方法回顾性纳入2023年1月—2024年3月汉中市中心医院神经内科一病区收治的LAA型和SAO型ACI患者。根据代谢状态与BMI将其分为代谢正常非肥胖型、代谢正常肥胖型、代谢异常非肥胖型、代谢异常肥胖型。比较LAA组与SAO组肥胖代谢表型的分布差异，并采用多因素logistic回归分析探讨肥胖代谢表型与ACI分型的关联。
结果共纳入ACI患者207例，其中LAA组105例，SAO组102例。LAA组以代谢异常肥胖型为主（66.67%），SAO组中代谢异常非肥胖型多见（47.06%），不同肥胖代谢表型在两组间的差异有统计学意义（P<0.001）。多因素logistic回归分析显示，在未校正混杂因素的模型1中，代谢异常肥胖型患者为LAA型ACI的可能性更高（OR 2.283，95%CI 1.093～4.766，P=0.028），而代谢异常非肥胖型患者为LAA型ACI的可能性较低（OR 0.171，95%CI 0.068～0.432，P<0.001）。在校正混杂因素后，代谢异常非肥胖型与LAA型ACI的负向关联仍具有统计学意义（OR 0.058，95%CI 0.017～0.194，P<0.001），而代谢异常肥胖型与ACI分型的关联不具有统计学意义。
结论在ACI患者中，代谢异常肥胖型与LAA型ACI相关，但该关联可能受混杂因素影响；代谢异常非肥胖型为SAO型ACI（相对于LAA型ACI）的强关联因素，提示不同肥胖代谢表型与ACI分型之间存在特异性关联。

文章导读： 本研究揭示了不同肥胖代谢表型可能与特定急性脑梗死分型存在关联：代谢异常肥胖型与大动脉粥样硬化型急性脑梗死存在关联，而代谢异常非肥胖型与小动脉闭塞型急性脑梗死存在关联。该关联为基于肥胖代谢表型的急性脑梗死个体化精准防控提供了参考依据。

关键词: 代谢表型; 肥胖症; 急性脑梗死; 病因分型

Abstract: Objective To investigate the association between different obesity metabolic phenotypes and acute cerebral infarction (ACI) subtypes, including large-artery atherosclerosis (LAA) and small-artery occlusion (SAO).
Methods A retrospective analysis was conducted on patients with LAA-type and SAO-type ACI admitted to the First Ward, Department of Neurology, Hanzhong Central Hospital from January 2023 to March 2024. Participants were divided into four groups according to BMI and metabolic status: metabolically healthy non-obese, metabolically healthy obese, metabolically unhealthy non-obese, and metabolically unhealthy obese. The distribution differences of obesity metabolic phenotypes between the LAA group and the SAO group were compared. Multivariate logistic regression analysis was performed to explore the association between obesity metabolic phenotypes and ACI subtypes.
Results A total of 207 ACI patients were enrolled, including 105 patients in the LAA group and 102 patients in the SAO group. The metabolically unhealthy obese phenotype was predominant in the LAA group (66.67%), while the metabolically unhealthy non-obese phenotype was the most common in the SAO group (47.06%). The difference in the distribution of obesity metabolic phenotypes between the two groups was statistically significant (P<0.001). Multivariate logistic regression analysis showed that in Model 1 without adjusting for confounding factors, metabolically unhealthy obese patients had a higher probability of developing LAA-type ACI (OR 2.283, 95%CI 1.093-4.766, P=0.028), while metabolically unhealthy non-obese patients were less likely to be LAA-type ACI (OR 0.171, 95%CI 0.068-0.432 P<0.001). After adjusting for confounding factors, the negative association between metabolically unhealthy non-obese phenotype and LAA-type ACI remained statistically significant (OR 0.058, 95%CI 0.017-0.194, P<0.001), while no significant association was found between the metabolically unhealthy obese phenotype and either ACI subtype.
Conclusions In ACI patients, the metabolically unhealthy obese phenotype is associated with LAA-type ACI, but this association may be affected by confounding factors. The metabolically unhealthy non-obese phenotype is strongly associated with SAO-type ACI (relative to LAA-type ACI), suggesting that specific associations exist between different obesity metabolic phenotypes and ACI subtypes.

Key words: Metabolic phenotype; Obesity; Acute cerebral infarction; Etiological classification

中图分类号:

汪怡君, 江远龙, 姜进, 于奇晋, 王衡, 薛延华, 白瑞瑞. 不同肥胖代谢表型与大动脉粥样硬化型和小动脉闭塞型急性脑梗死的关联性研究[J]. 中国卒中杂志, 2026, 21(2): 186-192.

WANG Yijun, JIANG Yuanlong, JIANG Jin, YU Qijin, WANG Heng, XUE Yanhua, BAI Ruirui. Association between Different Obesity Metabolic Phenotypes and Acute Cerebral Infarction Subtypes: Large-Artery Atherosclerosis versus Small-Artery Occlusion[J]. Chinese Journal of Stroke, 2026, 21(2): 186-192.

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