A preliminary study of the correlation between ultrasound detection of multi site visceral fat and cerebral ischemic stroke
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摘要:
目的 应用超声检测多部位内脏脂肪，评估其与缺血性脑卒中(CIS)的关联，识别相关风险因素，为CIS的早期诊断和预防提供新的视角。 方法 连续纳入2022年9月~2023年9月在皖南医学院弋矶山医院神经内科确诊为缺血性脑卒中的患者89例及健康志愿者90例，分别作为卒中组和对照组，采用超声技术测量多个部位内脏脂肪参数并进行组间比较。 结果 两组在中国人内脏脂肪指数、颈动脉内中膜厚度(IMT)、心外膜脂肪组织(EAT)、腹膜前脂肪厚度、右肾后周脂肪厚度、内脏脂肪体积及左右肾脂肪囊厚度等多个内脏脂肪参数的差异均有统计学意义（P < 0.05），其中EAT的OR值为2.258（1.805~2.834），明显高于其他指标。多因素Logistic回归分析显示，IMT（OR=1.004，P=0.013）、EAT(OR=4.040，P < 0.001)对CIS的影响有统计学意义；ROC曲线分析显示IMT、EAT的曲线下面积分别为0.708、0.882，有较高的敏感度，确定其临界值分别为1275 μm、17.54 mm。 结论 超声测量多部位内脏脂肪参数与CIS有关，IMT、EAT是CIS的独立影响因素，IMT、EAT值越大患CIS的风险越高，其中EAT的诊断效能更高；当超声检测的EAT超过临界值时，临床可以通过早期指导或干预以降低卒中的发病风险。 Abstract:Objective To evaluate the association between visceral fat in multi sites and cerebral ischemic stroke (CIS) by applying ultrasound detection, identify relevant risk factors, and provide a new perspective for the early diagnosis and prevention of CIS. Methods Eighty-nine patients diagnosed with CIS in the neurology department of Yijishan Hospital, Wannan Medical College as well as 90 healthy volunteers from September 2022 to September 2023 were included, as stroke group and control group respectively. Ultrasound technology was used to measure visceral fat parameters in multi sites, and compared between groups. Results The differences of Chinese visceral adiposity index, intima- media thickness (IMT), epicardial adipose tissue (EAT), preperitoneal fat thickness, posterior right periphery fat thickness, visceral adipose tissue and left or right renal fat sac thickness between the two groups were statistically significant (P < 0.05). The OR value of EAT was 2.258 (1.805-2.834), which was significantly higher than other indicators. After adjusting for multiple variables, multivariate Logistic regression analysis showed that IMT (OR=1.004, P=0.013) and EAT (OR=4.040, P < 0.001) had a statistically significant impact on CIS. ROC curve analysis determined that the AUC values of IMT and EAT were 0.708, 0.882, respectively, which had high sensitivity, and the critical values were 1275 μm and 17.54 mm, respectively. Conclusion Ultrasound measurement of multi sites visceral fat parameters is related to CIS, and IMT and EAT are independent influencing factors of CIS. The higher the IMT and EAT values, the higher the risk of developing CIS, with EAT having higher diagnostic efficacy. -
Key words:
- fat /
- visceral fat measurement /
- ultrasound detection /
- cerebral ischemic stroke
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图 2 IMT对照组(A)和卒中组(B)对比
Figure 2. Comparison between IMT control group (A) and stroke group (B)
图 3 EMT对照组(A)和卒中组(B)对比
Figure 3. Comparison between EMT control group (A) and stroke group (B)
图 4 EAT对照组(A)和卒中组(B)对比
Figure 4. Comparison between EAT control group(A) and stroke group(B)
图 5 PPFT对照组(A)和卒中组(B)对比
Figure 5. Comparison between PPFT control group (A) and stroke group (B)
图 6 SCFT对照组(A)和卒中组(B)对比
Figure 6. Comparison between SCFT control group (A) and stroke group (B)
图 7 VFT对照组(A)和卒中组(B)对比
Figure 7. Comparison between VFT control group (A) and stroke group (B)
图 8 PRPFT对照组(A)和卒中组(B)对比
Figure 8. Comparison between PRPFT control group (A) and stroke group (B)
图 9 肾周脂肪囊厚度对照组(A)和卒中组(B)对比
Figure 9. Comparison between perirenal fat sac thickness control group (A) and stroke group(B)
表 1 两组一般资料比较
Table 1. Comparison of general data of the two groups
Influence factors Control group(n=90) Stroke group (n=89) t/χ2/Z P Gender (Male/Female, n) 58/32 63/26 0.822 0.365 Age [years, M(P25, P75)] 59.00(55.50，69.50) 63.00(64.00，69.50) -1.792 0.073 BMI [kg/m2, M(P25, P75)] 23.81(21.60, 24.66) 24.10(22.50，24.80) -0.975 0.330 Waist [cm, M(P25, P75)] 86.00(82.00, 89.00) 87.00(83.00，90.00) -1.690 0.091 High D-Dimer (No/Yes, n) 75/15 68/21 1.337 0.246 Hypertension (No/Yes, n) 43/47 36/53 0.975 0.324 Diabetes (No/Yes, n) 78/12 73/16 0.731 0.392 Total cholesterol [mmol/L, M(P25, P75)] 4.32(3.94，4.79) 4.07(3.39，4.79) -1.480 0.139 Triglyceride [mmol/L, M(P25, P75)] 1.23(0.85, 1.81) 1.37(1.11, 1.70) -1.650 0.099 HDL-cholesterol [mmol/L, M(P25, P75)] 1.25(1.07，1.45) 1.15(0.92，1.49) -1.903 0.057 LDL-cholesterol [mmol/L, M(P25, P75)] 2.38(1.91，2.82) 2.27(1.87，2.92) -0.014 0.988 CVAI (Mean±SD) 96.10±19.42 107.33±19.18 3.891 < 0.001 CVAI: Chinese visceral adiposity index 
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表 2 两组测量指标比较
Table 2. Comparison of measurement factor between two groups
Influence factors Control group (n=90) Stroke group (n=89) t/Z P IMT (μm) 1205.00(955.00，1270.00) 1280.00(1220.00，1345.00) -4.818 < 0.001 EMT (mm) 0.81(0.72, 0.90) 0.80(0.70，0.90) -0.593 0.553 EAT (mm) 15.97(15.29, 16.80) 20.20(17.85, 21.34) -8.827 < 0.001 SCFT (mm) 12.25(10.98, 12.80) 12.00(10.85，13.35) -0.340 0.729 PPFT (mm) 12.40(10.98, 13.23) 12.90(11.80, 14.00) -3.114 0.002 VFT (mm) 55.37±8.29 57.60±9.18 1.700 0.091 PRPFT (mm) 4.80(4.20, 5.70) 6.50(5.20，7.90) -6.150 < 0.001 VFT/SCFT 4.61(4.32, 5.11) 4.83(4.25，5.32) -0.887 0.375 VAT (mm3) 139.64±11.53 149.58±13.32 5.344 < 0.001 Right renal fat sac (mm) 39.60(36.30，43.30) 43.20(36.85，51.50) -3.367 < 0.001 Left renal fat sac (mm) 39.10(35.90, 42.60) 41.10(36.40, 47.45) -2.425 0.015 IMT: Intima- media thickness; EMT: Extra- media thickness; EAT: Epicardial adipose tissue; SCFT: Subcutaneous fat thickness; PPFT: Preperitoneal fat thickness; VFT: Visceral fat thickness; PRPFT: Posterior right perinephric fat thickness; VAT: Visceral adipose tissue; .
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表 3 影响因素单因素Logistic回归分析
Table 3. Univariate Logistic regression analysis of the influencing factors
Influence factors β Standard error Wald χ2 OR (95% CI) P IMT (μm) 0.005 0.001 19.583 1.005(1.003-1.007) < 0.001 EAT (mm) 0.814 0.114 50.950 2.258(1.805-2.834) < 0.001 PPFT (mm) 0.358 0.102 12.238 1.431(1.171-1.749) < 0.001 PRPFT (mm) 0.805 0.137 34.382 2.238(1.710-2.929) < 0.001 VAT (mm3) 0.063 0.013 22.227 1.065(1.037-1.093) < 0.001 Right perirenal adipose sac (mm) 0.080 0.022 13.391 1.083(1.038-1.130) < 0.001 Left perirenal adipose sac (mm) 0.059 0.024 6.347 1.061(1.013-1.111) 0.012 CVAI 0.030 0.008 13.110 1.031(1.014-1.048) < 0.001
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表 4 影响因素多因素Logistic回归分析
Table 4. Multivariate Logistic regression analysis of the influencing factors
Influence factors β Standard error Wald χ2 OR (95% CI) P IMT (μm) 0.004 0.001 6.138 1.004(1.001-1.007) 0.013 EAT (mm) 1.396 0.252 30.586 4.040(2.463-6.626) < 0.001 PPFT (mm) -0.088 0.217 0.165 0.916(0.599-1.400) 0.685 PRPFT (mm) 0.447 0.294 2.309 1.564(0.878-2.786) 0.129 VAT (mm3) -0.035 0.039 0.812 0.966(0.89-1.042) 0.367 Right perirenal adipose sac (mm) -0.097 0.057 2.839 0.908(0.812-1.108) 0.092 Left perirenal adipose sac (mm) -0.088 0.059 2.192 0.916(0.815-1.029) 0.139 CVAI -0.025 0.017 2.177 0.976(0.944-1.008) 0.140
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