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Article(id=1324077696061415979, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511432, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764086400000, receivedDateStr=2025-11-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614322915, onlineDateStr=2026-11-02, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614322915, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614322915, creator=13701087609, updateTime=1793614322915, updator=13701087609, issue=Issue{id=1324077560820282023, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614290671, creator='13701087609', updateTime=1793614391469, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077983656444429, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077983660638734, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1075, endPage=1081, ext={EN=ArticleExt(id=1324077696493429292, articleId=1324077696061415979, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between ABSI and all-cause mortality in stroke patients, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the association between a body shape index (ABSI) and all-cause mortality in stroke patients.

Methods

Using data from 2005 to 2016 National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). The study involved 1 039 participants after applying exclusion criteria. The participants were divided into 5 groups. Continuous variables were expressed as （）, and the Kruskal-Wallis rank sum test was used. Categorical variables were expressed as n（%）, and Pearson’s χ2 was used. Kaplan-Meier survival analysis, cox proportional hazards model and restricted cubic splines were utilized to estimate the association between ABSI and All-cause mortality in stroke patients.

Results

The Kaplan-Meier survival analysis showed that the survival rate of patients with the high ABSI group was significantly lower than that of patients with the low ABSI group before and after weighting. Cox proportional hazards model showed that the high ABSI group(Q5) compared to the lowest quartile (Q1), was associated with a high incidence of all-cause mortality in stroke patients(before-weighting HR=2.41,95% CI:1.69-3.44; after-weighting HR=2.57,95% CI:1.62-4.07) after adjusting for potential confounders. Restricted cubic splines analysis showed that all-cause mortality in stroke patients increased significantly with ABSI exceeded a cutoff. Older adults and males are more susceptible to the ABSI. P<0.05 was considered as the difference was statistically significant.

Conclusion

The high ABSI group (Q5) is associated with a high incidence of all-cause mortality in stroke patients. ABSI is a risk factor for All-cause mortality in stroke patients.

, authors=Pei-yi MO, Bei-bei YAO, Zhao-yao CHEN, Wen-lei LI, Yuan ZHU, Ming-hua WU, authorsList=Pei-yi MO, Bei-bei YAO, Zhao-yao CHEN, Wen-lei LI, Yuan ZHU, Ming-hua WU, authorCompany=null, correspAuthors=Ming-hua WU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077700700316221, articleId=1324077696061415979, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=身体体型指数与脑卒中人群全因死亡的关系, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

分析身体体型指数（a body shape Index, ABSI）与脑卒中（stroke）人群全因死亡之间的关系。

方法

选取美国国家健康和营养调查（NHANES）和美国国家死亡索引（NDI） 2005—2016年数据库，纳入符合条件的1 039例脑卒中人群。按ABSI的五分位数将人群分为5组，连续变量用Kruskal-Wallis检验，以（）表示，分类变量用Pearson χ2检验，以n（%）表示。使用Kaplan-Meier生存分析、Cox比例风险回归模型和限制性立方样条分析评估ABSI与脑卒中人群全因死亡之间的关系。

结果

Kaplan-Meier生存分析显示，加权前后高ABSI组生存率均显著低于较低ABSI组。Cox风险比例回归模型显示，在校正协变量后，与最低五分位数组（Q1）相比，较高的ABSI组（Q5）与脑卒中人群的全因死亡风险升高有关（加权前HR=2.41，95% CI: 1.69~3.44；加权后HR=2.57，95% CI: 1.62~4.07）。限制性立方样条分析显示，当连续ABSI超过特定阈值后，死亡风险显著上升。差异具有统计学意义（P<0.05）。

结论

较高的ABSI组（Q5）与脑卒中人群的全因死亡风险升高相关, ABSI为脑卒中人群全因死亡的危险因素。

, authors=莫培艺, 姚蓓蓓, 陈兆耀, 李文磊, 朱元, 吴明华, authorsList=莫培艺, 姚蓓蓓, 陈兆耀, 李文磊, 朱元, 吴明华, authorCompany=null, correspAuthors=吴明华, authorNote=

莫培艺（1999—），女，硕士在读，研究方向：神经内科

, correspAuthorsNote=
吴明华，E-mail:
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莫培艺（1999—），女，硕士在读，研究方向：神经内科

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注：A为加权前；B为加权后。

, figureFileSmall=BB/vfkmteLVTsZXhB+QKAA==, figureFileBig=U7d6vFD0TL1y9BsXc3yijQ==, tableContent=null), ArticleFig(id=1324077707327316585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077696061415979, language=EN, label=Fig.3, caption=RCS of association between ABSI and all-Cause mortality in stroke patients, figureFileSmall=RPIuGiDYFmF2fLDW+ZHoog==, figureFileBig=vdfm2+denxQEpBCTIEfY7Q==, tableContent=null), ArticleFig(id=1324077707411202666, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077696061415979, language=CN, label=图3, caption=限制性立方样条分析ABSI与脑卒中人群全因死亡的关系

注：A为加权前按性别分层；B为加权前按年龄分层；C加权后按性别分层；D为加权后按年龄分层。

, figureFileSmall=RPIuGiDYFmF2fLDW+ZHoog==, figureFileBig=vdfm2+denxQEpBCTIEfY7Q==, tableContent=null), ArticleFig(id=1324077707478311531, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077696061415979, language=EN, label=Table 1, caption=

Baseline characteristics of stroke patients by ABSI quintilesl

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总参与者(n=1 039)Q1(n=208)Q2(n=208)Q3(n=207)Q4(n=208)Q5(n=208)统计量P值
年龄(岁)131.080<0.001
<4582(7.9)43(20.7)20(9.6)8(3.9)7(3.4)4(1.9)
≥65600(57.7)73(35.1)101(48.6)122(58.9)138(66.3)166(79.8)
45~64357(34.4)92(44.2)87(41.8)77(37.2)63(30.3)38(18.3)
性别58.444<0.001
女性538(51.8)153(73.6)113(54.3)86(41.5)99(47.6)87(41.8)
男性501(48.2)55(26.4)95(45.7)121(58.5)109(52.4)121(58.2)
种族85.723<0.001
墨西哥裔美国人101(9.7)18(8.7)18(8.7)28(13.5)19(9.1)18(8.7)
非西班牙裔黑人283(27.2)86(41.3)76(36.5)47(22.7)47(22.6)27(13.0)
非西班牙裔白人524(50.4)84(40.4)88(42.3)93(44.9)111(53.4)148(71.2)
其他西班牙裔66(6.4)8(3.8)13(6.3)22(10.6)16(7.7)7(3.4)
其他65(6.3)12(5.8)13(6.3)17(8.2)15(7.2)8(3.8)
教育程度6.7460.564
大学及以上402(38.7)89(42.8)86(41.3)79(38.2)75(36.1)73(35.1)
高中及同等学历275(26.5)58(27.9)56(26.9)53(25.6)53(25.5)55(26.4)
高中以下362(34.8)61(29.3)66(31.7)75(36.2)80(38.5)80(38.5)
婚姻3.3250.505
已婚/同居529(50.9)98(47.1)107(51.4)115(55.6)107(51.4)102(49.0)
其他510(49.1)110(52.9)101(48.6)92(44.4)101(48.6)106(51.0)
PIR9.9130.271
高180(17.3)37(17.8)44(21.2)41(19.8)29(13.9)29(13.9)
低423(40.7)87(41.8)73(35.1)85(41.1)95(45.7)83(39.9)
中436(42.0)84(40.4)91(43.8)81(39.1)84(40.4)96(46.2)
吸烟史641(61.7)110(52.9)123(59.1)129(62.3)133(63.9)146(70.2)14.2430.007
饮酒史677(65.2)125(60.1)142(68.3)141(68.1)129(62.0)140(67.3)5.3580.252
身高(m)1.7±0.11.6±0.11.7±0.11.7±0.11.7±0.11.7±0.19.5410.049
体重(kg)81.8±20.585.2±24.082.2±21.982.7±20.880.3±18.278.4±16.36.7070.152
腰围(m)1.0±0.21.0±0.21.0±0.21.0±0.21.1±0.11.1±0.166.083<0.001
BMI(kg/m2)29.7±6.731.7±8.830.0±6.729.9±6.428.9±5.528.2±4.818.1150.001
高血压836(80.5)150(72.1)170(81.7)173(83.6)163(78.4)180(86.5)16.1730.003
糖尿病402(38.7)64(30.8)72(34.6)89(43.0)88(42.3)89(42.8)11.1950.024
高脂血症837(80.6)159(76.4)168(80.8)172(83.1)169(81.3)169(81.3)3.2310.520
肥胖570(54.9)130(62.5)121(58.2)115(55.6)101(48.6)103(49.5)11.5970.021
血清空腹血糖(mmol/L)3.3±3.83.3±3.73.0±3.43.5±4.23.6±4.03.2±3.62.1920.700
血清糖化血红蛋白(%)5.9±1.85.8±1.55.8±1.86.2±2.16.0±1.95.9±1.86.9280.140
血清总胆固醇(mmol/L)4.5±1.64.7±1.54.7±1.74.5±1.74.4±1.64.4±1.713.4180.009
血清高密度脂蛋白(mmol/L)1.3±0.51.3±0.61.3±0.51.2±0.51.2±0.41.2±0.522.659<0.001
血清低密度脂蛋白(mmol/L)1.3±1.51.4±1.61.3±1.71.3±1.51.3±1.41.2±1.52.2440.691
血清甘油三酯(mmol/L)0.7±1.20.7±0.90.6±0.90.7±0.90.9±1.90.8±1.21.9330.748
血清白细胞(×109/L)7.5±2.77.2±2.07.5±3.47.6±3.47.5±2.27.8±2.210.4940.033
血清红细胞(×1012/L)4.5±0.64.5±0.54.5±0.64.6±0.54.5±0.54.4±0.69.7940.044
血清血红蛋白(g/L)136.5±16.4132.8±15.1137.6±15.4138.6±15.6136.8±16.3136.7±18.817.6270.001
血清血小板(×109/L)241.2±76.1256.2±78.2247.1±71.5233.5±75.0239.0±82.5230.3±70.319.016<0.001
尿肌酐(mmol/L)10.5±7.011.1±7.311.2±8.410.7±6.99.8±6.39.7±5.74.8270.306
), ArticleFig(id=1324077707570586220, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077696061415979, language=CN, label=表1, caption=

按ABSI五分位数分层的脑卒中人群基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总参与者(n=1 039)Q1(n=208)Q2(n=208)Q3(n=207)Q4(n=208)Q5(n=208)统计量P值
年龄(岁)131.080<0.001
<4582(7.9)43(20.7)20(9.6)8(3.9)7(3.4)4(1.9)
≥65600(57.7)73(35.1)101(48.6)122(58.9)138(66.3)166(79.8)
45~64357(34.4)92(44.2)87(41.8)77(37.2)63(30.3)38(18.3)
性别58.444<0.001
女性538(51.8)153(73.6)113(54.3)86(41.5)99(47.6)87(41.8)
男性501(48.2)55(26.4)95(45.7)121(58.5)109(52.4)121(58.2)
种族85.723<0.001
墨西哥裔美国人101(9.7)18(8.7)18(8.7)28(13.5)19(9.1)18(8.7)
非西班牙裔黑人283(27.2)86(41.3)76(36.5)47(22.7)47(22.6)27(13.0)
非西班牙裔白人524(50.4)84(40.4)88(42.3)93(44.9)111(53.4)148(71.2)
其他西班牙裔66(6.4)8(3.8)13(6.3)22(10.6)16(7.7)7(3.4)
其他65(6.3)12(5.8)13(6.3)17(8.2)15(7.2)8(3.8)
教育程度6.7460.564
大学及以上402(38.7)89(42.8)86(41.3)79(38.2)75(36.1)73(35.1)
高中及同等学历275(26.5)58(27.9)56(26.9)53(25.6)53(25.5)55(26.4)
高中以下362(34.8)61(29.3)66(31.7)75(36.2)80(38.5)80(38.5)
婚姻3.3250.505
已婚/同居529(50.9)98(47.1)107(51.4)115(55.6)107(51.4)102(49.0)
其他510(49.1)110(52.9)101(48.6)92(44.4)101(48.6)106(51.0)
PIR9.9130.271
高180(17.3)37(17.8)44(21.2)41(19.8)29(13.9)29(13.9)
低423(40.7)87(41.8)73(35.1)85(41.1)95(45.7)83(39.9)
中436(42.0)84(40.4)91(43.8)81(39.1)84(40.4)96(46.2)
吸烟史641(61.7)110(52.9)123(59.1)129(62.3)133(63.9)146(70.2)14.2430.007
饮酒史677(65.2)125(60.1)142(68.3)141(68.1)129(62.0)140(67.3)5.3580.252
身高(m)1.7±0.11.6±0.11.7±0.11.7±0.11.7±0.11.7±0.19.5410.049
体重(kg)81.8±20.585.2±24.082.2±21.982.7±20.880.3±18.278.4±16.36.7070.152
腰围(m)1.0±0.21.0±0.21.0±0.21.0±0.21.1±0.11.1±0.166.083<0.001
BMI(kg/m2)29.7±6.731.7±8.830.0±6.729.9±6.428.9±5.528.2±4.818.1150.001
高血压836(80.5)150(72.1)170(81.7)173(83.6)163(78.4)180(86.5)16.1730.003
糖尿病402(38.7)64(30.8)72(34.6)89(43.0)88(42.3)89(42.8)11.1950.024
高脂血症837(80.6)159(76.4)168(80.8)172(83.1)169(81.3)169(81.3)3.2310.520
肥胖570(54.9)130(62.5)121(58.2)115(55.6)101(48.6)103(49.5)11.5970.021
血清空腹血糖(mmol/L)3.3±3.83.3±3.73.0±3.43.5±4.23.6±4.03.2±3.62.1920.700
血清糖化血红蛋白(%)5.9±1.85.8±1.55.8±1.86.2±2.16.0±1.95.9±1.86.9280.140
血清总胆固醇(mmol/L)4.5±1.64.7±1.54.7±1.74.5±1.74.4±1.64.4±1.713.4180.009
血清高密度脂蛋白(mmol/L)1.3±0.51.3±0.61.3±0.51.2±0.51.2±0.41.2±0.522.659<0.001
血清低密度脂蛋白(mmol/L)1.3±1.51.4±1.61.3±1.71.3±1.51.3±1.41.2±1.52.2440.691
血清甘油三酯(mmol/L)0.7±1.20.7±0.90.6±0.90.7±0.90.9±1.90.8±1.21.9330.748
血清白细胞(×109/L)7.5±2.77.2±2.07.5±3.47.6±3.47.5±2.27.8±2.210.4940.033
血清红细胞(×1012/L)4.5±0.64.5±0.54.5±0.64.6±0.54.5±0.54.4±0.69.7940.044
血清血红蛋白(g/L)136.5±16.4132.8±15.1137.6±15.4138.6±15.6136.8±16.3136.7±18.817.6270.001
血清血小板(×109/L)241.2±76.1256.2±78.2247.1±71.5233.5±75.0239.0±82.5230.3±70.319.016<0.001
尿肌酐(mmol/L)10.5±7.011.1±7.311.2±8.410.7±6.99.8±6.39.7±5.74.8270.306
), ArticleFig(id=1324077707654472301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077696061415979, language=EN, label=Table 2, caption=

Cox proportional hazards model of association between ABSI and all-Cause mortality in stroke patients

, figureFileSmall=null, figureFileBig=null, tableContent=
分组变量加权前加权后
HR95%CIP值HR95%CIP值
模型1ABSI
Q1----
Q21.420.96~2.080.0761.520.98~2.360.059
Q32.111.46~3.03<0.0012.511.56~4.05<0.001
Q42.391.67~3.41<0.0012.711.70~4.34<0.001
Q54.223.01~5.91<0.0014.412.90~6.73<0.001
模型2ABSI
Q1----
Q21.170.79~1.720.4391.170.78~1.760.448
Q31.501.03~2.190.0331.721.04~2.870.036
Q41.581.09~2.290.0151.681.01~2.810.046
Q52.531.78~3.60<0.0012.661.68~4.22<0.001
模型3ABSI
Q1----
Q21.140.78~1.690.4961.140.75~1.730.529
Q31.450.99~2.110.0551.590.96~2.620.072
Q41.521.05~2.200.0281.620.99~2.670.057
Q52.411.69~3.44<0.0012.571.62~4.07<0.001
), ArticleFig(id=1324077707738358382, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077696061415979, language=CN, label=表2, caption=

ABSI与脑卒中人群全因死亡的Cox回归

, figureFileSmall=null, figureFileBig=null, tableContent=
分组变量加权前加权后
HR95%CIP值HR95%CIP值
模型1ABSI
Q1----
Q21.420.96~2.080.0761.520.98~2.360.059
Q32.111.46~3.03<0.0012.511.56~4.05<0.001
Q42.391.67~3.41<0.0012.711.70~4.34<0.001
Q54.223.01~5.91<0.0014.412.90~6.73<0.001
模型2ABSI
Q1----
Q21.170.79~1.720.4391.170.78~1.760.448
Q31.501.03~2.190.0331.721.04~2.870.036
Q41.581.09~2.290.0151.681.01~2.810.046
Q52.531.78~3.60<0.0012.661.68~4.22<0.001
模型3ABSI
Q1----
Q21.140.78~1.690.4961.140.75~1.730.529
Q31.450.99~2.110.0551.590.96~2.620.072
Q41.521.05~2.200.0281.620.99~2.670.057
Q52.411.69~3.44<0.0012.571.62~4.07<0.001
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身体体型指数与脑卒中人群全因死亡的关系
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莫培艺 , 姚蓓蓓 , 陈兆耀 , 李文磊 , 朱元 , 吴明华
现代预防医学 | 健康与社会行为 2026,53(6): 1075-1081
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现代预防医学 |健康与社会行为 2026 , 53 (6) : 1075 -1081
身体体型指数与脑卒中人群全因死亡的关系
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莫培艺, 姚蓓蓓, 陈兆耀, 李文磊, 朱元, 吴明华
作者信息
  • 南京中医药大学附属医院江苏省中医院神经内科，江苏 南京 210029
通讯作者:
吴明华，E-mail:
作者简介:

莫培艺（1999—），女，硕士在读，研究方向：神经内科

Association between ABSI and all-cause mortality in stroke patients
Pei-yi MO, Bei-bei YAO, Zhao-yao CHEN, Wen-lei LI, Yuan ZHU, Ming-hua WU
Affiliations
  • Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, China
出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202511432
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摘要
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目的

分析身体体型指数（a body shape Index, ABSI）与脑卒中（stroke）人群全因死亡之间的关系。

方法

选取美国国家健康和营养调查（NHANES）和美国国家死亡索引（NDI） 2005—2016年数据库，纳入符合条件的1 039例脑卒中人群。按ABSI的五分位数将人群分为5组，连续变量用Kruskal-Wallis检验，以（）表示，分类变量用Pearson χ2检验，以n（%）表示。使用Kaplan-Meier生存分析、Cox比例风险回归模型和限制性立方样条分析评估ABSI与脑卒中人群全因死亡之间的关系。

结果

Kaplan-Meier生存分析显示，加权前后高ABSI组生存率均显著低于较低ABSI组。Cox风险比例回归模型显示，在校正协变量后，与最低五分位数组（Q1）相比，较高的ABSI组（Q5）与脑卒中人群的全因死亡风险升高有关（加权前HR=2.41，95% CI: 1.69~3.44；加权后HR=2.57，95% CI: 1.62~4.07）。限制性立方样条分析显示，当连续ABSI超过特定阈值后，死亡风险显著上升。差异具有统计学意义（P<0.05）。

结论

较高的ABSI组（Q5）与脑卒中人群的全因死亡风险升高相关, ABSI为脑卒中人群全因死亡的危险因素。

身体体型指数  /  脑卒中  /  全因死亡
Objective

To evaluate the association between a body shape index (ABSI) and all-cause mortality in stroke patients.

Methods

Using data from 2005 to 2016 National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). The study involved 1 039 participants after applying exclusion criteria. The participants were divided into 5 groups. Continuous variables were expressed as （）, and the Kruskal-Wallis rank sum test was used. Categorical variables were expressed as n（%）, and Pearson’s χ2 was used. Kaplan-Meier survival analysis, cox proportional hazards model and restricted cubic splines were utilized to estimate the association between ABSI and All-cause mortality in stroke patients.

Results

The Kaplan-Meier survival analysis showed that the survival rate of patients with the high ABSI group was significantly lower than that of patients with the low ABSI group before and after weighting. Cox proportional hazards model showed that the high ABSI group(Q5) compared to the lowest quartile (Q1), was associated with a high incidence of all-cause mortality in stroke patients(before-weighting HR=2.41,95% CI:1.69-3.44; after-weighting HR=2.57,95% CI:1.62-4.07) after adjusting for potential confounders. Restricted cubic splines analysis showed that all-cause mortality in stroke patients increased significantly with ABSI exceeded a cutoff. Older adults and males are more susceptible to the ABSI. P<0.05 was considered as the difference was statistically significant.

Conclusion

The high ABSI group (Q5) is associated with a high incidence of all-cause mortality in stroke patients. ABSI is a risk factor for All-cause mortality in stroke patients.

A body shape index  /  Stroke  /  All-cause mortality
莫培艺, 姚蓓蓓, 陈兆耀, 李文磊, 朱元, 吴明华. 身体体型指数与脑卒中人群全因死亡的关系. 现代预防医学, 2026 , 53 (6) : 1075 -1081 . DOI: 10.20043/j.cnki.MPM.202511432
Pei-yi MO, Bei-bei YAO, Zhao-yao CHEN, Wen-lei LI, Yuan ZHU, Ming-hua WU. Association between ABSI and all-cause mortality in stroke patients[J]. Modern Preventive Medicine, 2026 , 53 (6) : 1075 -1081 . DOI: 10.20043/j.cnki.MPM.202511432
正文
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脑卒中是全球高发的最主要的致死、致残性疾病之一[1]。根据2023年全球疾病负担数据库(global bur den of disease, GBD)统计显示[2]，脑卒中在全球伤残调整寿命年（disability-adjusted life years，DALYs）位居第三。随着全球人口增长及老龄化的加速，未来脑卒中带来的负担将更加沉重[3]。其防控形势将更加严峻。
肥胖作为脑卒中可干预的危险因素之一[4-5]，有证据表明[6]，较高的脂肪含量会导致较高的死亡风险。目前常用反映肥胖的指标有身体质量指数（body mass index，BMI）、腰围（waist circumference，WC）等，但BMI、WC无法精确衡量体脂[7]。Krakauer[8]等人开发的身体体型指数，这是一种基于腰围的相对独立于BMI的新型体型指数[9]。有相关研究显示，ABSI比BMI和腰围对死亡的预测更准确[10]，在脑卒中人群全因死亡的预测中有很大潜力。本研究针对脑卒中人群，分析ABSI与全因死亡的风险关联。
1　对象与方法
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1.1　研究对象
美国国家健康和营养调查（National Health and Nutrition Examination Survey，NHANES）是美国进行的一项包括所有年龄段参与者的人口统计数据、检查数据、实验室数据和问卷数据等的全国性调查，旨在衡量美国全人群的健康和营养状况。美国国家卫生统计中心（National Center for Health Statistics，NCHS）伦理审查委员会（Ethics review board，ERB）及其前身已经批准了每项 NHANES 研究方案（伦理审查协议编号：#2005-06、#2011-17），所有参与者都已签署知情同意书。为了解脑卒中人群ABSI与全因死亡率的关系，本研究从NHANES数据库收集了2005—2016年（6个调查周期）60 936名参与者的人口统计数据、检查数据、实验室数据和问卷数据，并通过链接NCHS的国家死亡指数（National death index，NDI）数据库获得参与者的生存状态（数据截至2019年12月31日），构建纵向队列研究。本研究选择脑卒中人群作为研究对象，共1 318例。经以下排除标准筛选：①年龄<20岁（n=0）；②生存状态缺失（n=2）；③关键指标（身高、体重、BMI、腰围）缺失（n=276）；④调查期间为孕期（n=1）。最终纳入1 039名参与者进行分析，筛选流程见图1。
1.2　研究方法
1.2.1　暴露变量
本研究的暴露变量为ABSI，有关计算指标为身高、BMI、腰围。其中身高（height）、腰围单位以m表示，BMI单位以kg/m2表示，通过调整腰围与身高和BMI的关系进行计算。公式如下[8]：
1.2.2　结局变量
本研究观察的主要结局是脑卒中人群的全因死亡率。其中脑卒中人群是根据问卷中的问题“医生告知你有脑卒中？”，问卷有是、否、拒绝回答、不知道四种答案及缺失数据。其中回答“是”的参与者被归为脑卒中人群。
1.2.3　协变量
本研究收集除上述身高、BMI、腰围外的协变量：年龄、性别、种族、教育程度、婚姻、贫困收入比（poverty income ratio，PIR）、吸烟史、饮酒史、体重、高血压、糖尿病、高脂血症、肥胖、空腹血糖、糖化血红蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三酯、白细胞、红细胞、血红蛋白、血小板、尿肌酐。其中PIR分为低（<1.3）、中（1.3-3.5）、高（>3.5）三组。吸烟史问卷项目为“生活中至少吸100支过烟”及“现在有吸烟”，其中一个问题回答“是”则可判断为有吸烟史。饮酒史问卷项目为“1年内至少饮用过12杯酒”，回答“是”则可判断为有饮酒史。高血压问卷项目为“医生告知你有高血压？”，回答“是”则可判断为有高血压，或者第1、2、3次血压测量的收缩压平均值≥140 mmHg/舒张压平均值≥90 mmHg[11]可判断为有高血压。糖尿病问卷项目为“医生告知你有糖尿病？”，回答“是”则可判断为有糖尿病，或者空腹血糖≥7.0 mmol/L/糖化血红蛋白≥6.5 %[12]可判断为有糖尿病。高脂血症问卷项目为“医生告知你有高脂血症？”，回答“是”则可判断为有高脂血症，或者总胆固醇≥5.2 mmol/L /高密度脂蛋白<1.0 mmol/L /低密度脂蛋白≥3.4 mmol/L /甘油三酯≥1.7 mmol/L [13]可判断为有高脂血症。肥胖问卷项目为“医生告知你有肥胖？”，回答“是”则可判断为有肥胖，或者BMI≥30 kg/m2[14]可判断为有肥胖。
1.2.4　统计学分析
统计分析及可视化采用R 4.5.1软件，运用mice包进行多重插补（multiple imputation，MI）填补缺失数据，生成20个数据集后[15]，选择AIC、BIC最小的1个数据集[16]进行统计分析。遵循NHANES的加权分析方法，通过WTMEC2YR/6计算得到权重，对数据进行加权以降低统计偏差。分别对加权前后数据进行分析。通过五分位数分组法，将ABSI的数值按升序排列后将人群划分为5个数据量相同的等分区间：第1五分位组（Quintile 1，Q1）ABSI数值范围为0.067 315 5~0.080 733 4，第2五分位组（Quintile 2，Q2）数值范围为0.080 765 7~0.083 468 7，第3五分位组（Quintile 3，Q3）数值范围为0.083 468 9~0.085 962 2，第4五分位组（Quintile 4，Q4）数值范围为0.085 976 1~0.088 784 1，第5五分位组（Quintile 5，Q5）数值范围为0.088 805 0~0.099 529 7。不同ABSI组的连续变量采用Kruskal-Wallis检验进行分析，用（）表示。分类变量采用Pearson χ2检验进行分析，以n（%）表示。
使用Kaplan-Meier生存分析计算预测生存率，绘制生存曲线。采用Cox风险比例回归模型分析脑卒中人群ABSI与全因死亡率的关系：模型1为单因素分析；模型2调整年龄、性别、教育程度及婚姻；模型3在模型2的基础上进一步调整吸烟史、饮酒史、高血压、糖尿病、高脂血症及肥胖。并通过限制性立方样条分析（restricted cubic splines analysis，RCS analysis）进一步评估两者之间的关系。
2　结果
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2.1　研究对象的基线特征
此研究纳入1 039名参与者，加权后ABSI五分位数分层的基线特征的比较见表1。结果显示，随着ABSI的增加，年龄、性别、种族、吸烟史、身高、腰围、BMI、高血压、糖尿病、肥胖、总胆固醇、高密度脂蛋白、白细胞、红细胞、血红蛋白、血小板等差异有统计学意义（P均<0.05）。教育程度、婚姻、PIR、饮酒史、体重、高脂血症、空腹血糖、糖化血红蛋白、低密度脂蛋白、甘油三酯、尿肌酐等变量之间的差异无统计学意义。
2.2　Kaplan-Meier生存分析
Kaplan-Meier生存分析显示，加权前后的高ABSI组生存率均低于较低ABSI组，与Q1组相比，Q2、Q3、Q4及Q5组的脑卒中人群全因死亡率更高，均存在显著差异(Log-rank检验P<0.001)。见图2。
2.3　Cox比例风险回归模型分析
在平均107个月的随访期间，403例调查对象死亡。加权前数据Cox风险比例回归模型分析结果显示，在模型1中，以Q1组为参照，Q3、Q4、Q5脑卒中人群全因死亡的HR（95% CI）分别为2.11（1.46~3.03）、2.39（1.67~3.41）、4.22（3.01~5.91）。在模型2中，以Q1组为参照，Q3、Q4、Q5脑卒中人群全因死亡的HR（95% CI）分别为1.50（1.03~2.19）、1.58（1.09~2.29）、2.53（1.78~3.60）。在模型3中，以Q1组为参照，Q4、Q5脑卒中人群全因死亡的HR（95% CI）分别为1.52（1.05~2.20）、2.41（1.69~3.44）。加权后数据结果显示，在模型1中，以Q1组为参照，Q3、Q4、Q5脑卒中人群全因死亡的HR（95% CI）分别为2.51（1.56~4.05）、2.71（1.70~4.34）、4.41（2.90~6.73）。在模型2中，以Q1组为参照，Q3、Q4、Q5脑卒中人群全因死亡的HR（95% CI）分别为1.72（1.04~2.87）、1.68（1.01~2.81）、2.66（1.68~4.22）。在模型3中，以Q1组为参照，Q5脑卒中人群全因死亡的HR（95% CI）为2.57（1.62~4.07）。以上结果具有统计学意义（P<0.05）。见表2。
2.4　限制性立方样条分析
将ABSI作为连续变量构建限制性立方样条模型见图3，在调整多项混杂因素后，加权后数据中ABSI与脑卒中人群之间存在显著的非线性关系（P<0.001）。加权前数据显示，男性拐点为0.083，女性及≥65岁群体拐点为0.085，45~64岁群体拐点为0.096。加权后数据显示，男性拐点为0.084，女性及≥65岁群体拐点为0.085。超过拐点后的死亡风险均显著上升。按性别进行分层后显示，男性较女性对ABSI的变化敏感。对数据按年龄进行分层后显示，年龄越高对ABSI的变化越敏感。
3　讨论
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研究结果显示，ABSI与脑卒中人群死亡风险升高有关。本研究结果为预测脑卒中人群的死亡风险提供了科学依据，能够更具针对性地对脑卒中进行干预。ABSI作为一种肥胖指标，进一步验证了肥胖与脑卒中的不良预后相关。ABSI不受“肥胖悖论”的影响[17]，能更好地反映和预测内脏脂肪相关风险。ABSI的公式是基于美国人群数据建立，中国有关学者在此基础上构建了适用于中国成人的公式[18]。中国[19]、日本[20]等国家的相关研究显示，ABSI是脑卒中人群全因死亡的危险因素。
但本研究也有一定的局限性，脑卒中人群的纳入仅参考了问卷调查，并没有实质证据。并且由于NHANES数据库为抽样调查，并且统计中存在研究人群同时具有其他高发疾病[21] 、测量方式具有差异、数据整理清理过程中引入错误等混杂因素[22]，导致误差产生，影响最终结果。因此，未来需扩大样本量，考虑更多的混杂因素，进一步完善研究。其中不同国家地区及种族的人群具有差异[23]，还可从这一方面细化分析。本研究缺少ABSI与BMI、WC以及身体圆形指数（body roundness index, BRI）等新型指标之间的对比分析，ABSI的适用性还需进一步验证。除此之外，有学者对ABSI与脑卒中发生率的关系进行研究[9,20,24]，但尚无定论，可以从这一角度出发深入研究。未来可以向更多方向和层次发展，以便临床工作者选择合适指标评估脑卒中人群的机体状态及预后。
基金
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  • 国家自然科学基金项目(82274428)
  • 江苏省卫健委重点项目(K2023009)
文献
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2026年第53卷第6期
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doi: 10.20043/j.cnki.MPM.202511432
  • 接收时间：2025-11-26
  • 首发时间：2026-11-02
  • 出版时间：2026-03-25
补充材料
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出版历史
  • 收稿日期：2025-11-26
基金
国家自然科学基金项目(82274428)
江苏省卫健委重点项目(K2023009)
作者信息
    南京中医药大学附属医院江苏省中医院神经内科，江苏 南京 210029

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吴明华，E-mail:
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202511432
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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