胃肠功能紊乱和首发缺血性卒中的风险

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胃肠功能紊乱和首发缺血性卒中的风险

翻译：冯玉蓉  编辑：冯玉蓉  审校：曹莹

背景和目的：新近研究表明，正常肠道菌群的改变会加重动脉粥样硬化和心血管疾病。虽然已知许多胃肠道疾病会破坏人体正常肠道微生物菌群，但胃肠道疾病对随后发生的脑血管疾病的临床影响仍不清楚。我们对胃肠道疾病与缺血性卒中的关系进行了探索性分析。

方法：我们采用2008年至2015年期间，具有全国代表性的5%的联邦医疗保险受益人样本进行回顾性队列研究。本研究只纳入年龄≥66岁的医保受益人。我们使用先前验证过的诊断代码来确定缺血性卒中的主要结果。并以探索性方式将胃肠道疾病按解剖位置、慢性疾病和疾病机制进行分类。我们使用Cox比例风险模型来检验胃肠道疾病类型与经人口统计学特征及明确血管危险因素调整后的缺血性卒中之间的关系。

结果：在每项分析的平均1725246名受益人中，对既定的卒中危险因素进行调整后，几种胃肠道疾病与缺血性卒中风险增加相关。最显著的正相关疾病包括胃疾病（危险比1.17 [95% CI, 1.15 - 1.19])、功能性疾病(1.16 [95% CI, 1.15 - 1.17])、炎症性疾病(1.13 [95% CI, 1.12 - 1.15]），以及感染性胃肠道疾病（1.13[95%CI, 1.12-1.15]）。相比之下，我们发现肛门和直肠疾病（0.97[95%CI, 0.94-1.00]）或胃肠道肿瘤性疾病（0.97[95%CI, 0.94-1.00]）与卒中无关。

结论：在本项探索性分析中，对人口统计学特征和既定的卒中危险因素进行调整后，几种胃肠道疾病（胃疾病、功能性疾病、炎症性疾病、感染性胃肠道疾病）与随后发生的缺血性卒中的风险增加相关。

原始文献来源：Roth WH, Cai A, Zhang C, et al. Gastrointestinal Disorders and Risk of First-Ever Ischemic Stroke.[J].Stroke. 2020 Oct 12:STROKEAHA120030643. doi: 10.1161/STROKEAHA.120.030643.

Gastrointestinal Disorders and Risk of First-Ever Ischemic Stroke

BACKGROUND AND PURPOSE: Recent studies suggest that alteration of the normal gut microbiome contributes to atherosclerotic burden and cardiovascular disease. While many gastrointestinal diseases are known to cause disruption of the normal gut microbiome in humans, the clinical impact of gastrointestinal diseases on subsequent cerebrovascular disease remains unknown. We conducted an exploratory analysis evaluating the relationship between gastrointestinal diseases and ischemic stroke.

METHODS: We performed a retrospective cohort study using claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included only beneficiaries ≥66 years of age. We used previously validated diagnosis codes to ascertain our primary outcome of ischemic stroke. In an exploratory manner, we categorized gastrointestinal disorders by anatomic location, disease chronicity, and disease mechanism. We used Cox proportional hazards models to examine associations of gastrointestinal disorder categories and ischemic stroke with adjustment for demographics and established vascular risk factors.

RESULTS: Among a mean of 1725246 beneficiaries in each analysis, several categories of gastrointestinal disorders were associated with an increased risk of ischemic stroke after adjustment for established stroke risk factors. The most notable positive associations included disorders of the stomach (hazard ratio, 1.17 [95% CI, 1.15–1.19]) and functional (1.16 [95% CI, 1.15–1.17]), inflammatory (1.13 [95% CI, 1.12–1.15]), and infectious gastrointestinal disorders (1.13 [95% CI, 1.12– 1.15]). In contrast, we found no associations with stroke for diseases of the anus and rectum (0.97 [95% CI, 0.94–1.00]) or neoplastic gastrointestinal disorders (0.97 [95% CI, 0.94–1.00]).

CONCLUSIONS: In exploratory analyses, several categories of gastrointestinal disorders were associated with an increased risk of future ischemic stroke after adjustment for demographics and established stroke risk factors.

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