游离脂肪酸与老年自发性脑出血患者90 d死亡风险的关联性

doi:10.3969/j.issn.1003-9198.2026.07.010

摘要/Abstract

摘要： 目的探讨老年自发性脑出血(sICH)患者入院时血清游离脂肪酸(FFA)水平与其90 d全因死亡风险之间的关联。方法选取564例年龄＞60岁的sICH患者进行回顾性研究。收集所有患者的性别、年龄、吸烟史、饮酒史、血压、基础疾病、NIHSS评分、FFA、血脂、血常规、血肿体积、活化部分凝血活酶时间(APTT)等基线资料。根据FFA中位数水平将患者分为低水平组(FFA≤0.40 mmol/L,n=293)和高水平组(FFA＞0.40 mmol/L,n=271),对所有患者进行出院后90 d随访,结局事件为全因死亡发生。通过单因素和多因素Cox回归模型分析FFA与老年sICH患者90 d全因死亡风险的关联性。采用Pearson相关系数描述FFA水平与血肿体积的相关性。以FFA为自变量,血肿体积为中介变量,90 d死亡率为因变量,采用Bootstrap法进行中介效应分析。结果不同FFA水平的老年sICH患者在收缩压、血肿体积、HDL-C、脂蛋白a、载脂蛋白B及死亡率方面差异均有统计学意义(P<0.05)。Log-rank检验显示,不同FFA水平的老年sICH患者在90 d死亡风险方面存在显著差异(P<0.05)。单因素Cox回归分析显示,年龄、FFA、血肿体积、NIHSS评分、WBC、高血压、吸烟及APTT与老年sICH患者的90 d全因死亡率相关(P<0.05)。多因素Cox回归分析显示,在校正血肿体积、NIHSS评分、APTT、WBC、年龄及舒张压的影响后,FFA仍是老年sICH患者90 d全因死亡的独立影响因素(HR=2.803,95%CI:1.032~7.611)。Pearson相关分析表明,FFA与血肿体积呈正相关(r=0.161,P＜0.001)。中介效应分析显示,FFA通过血肿体积影响患者90 d死亡的间接效应为0.351(95%CI:0.123~0.663)。结论入院FFA水平与老年sICH患者90 d死亡风险显著相关,其可能通过血肿体积影响老年sICH患者的90 d死亡率。

关键词: 游离脂肪酸, 自发性脑出血, 老年人, 死亡风险, 全因死亡率

Abstract: Objective To investigate the association between serum free fatty acid (FFA) level measured at admission and 90-day mortality in elderly patients with spontaneous intracerebral hemorrhage (sICH). Methods A retrospective study was conducted on 564 patients aged >60 years with sICH. Baseline data, including sex, age, smoking history, alcohol consumption history, blood pressure, comorbidities, National Institutes of Health Stroke Scale (NIHSS) score, FFA, blood lipid profile, blood routine index, hematoma volume, and activated partial thromboplastin time (APTT), were collected from all enrolled patients. Patients were divided into a low FFA group (FFA≤0.40 mmol/L, n=293) and a high FFA group (FFA>0.40 mmol/L, n=271) based on median serum FFA level. All patients were followed up for 90 days following discharge, with the outcome defined as all-cause mortality. Univariate and multivariate Cox proportional hazards regression models were employed to analyze the association between serum FFA level and the risk of 90-day all-cause mortality in elderly patients with sICH. Pearson correlation analysis was performed to examine the relationship between FFA level and hematoma volume. Mediation analysis was conducted via the bootstrap method, with FFA as the independent variable, hematoma volume as the mediator, and 90-day mortality as the dependent variable. Results Significant differences were observed in systolic blood pressure, hematoma volume, high-density lipoprotein cholesterol, lipoprotein(a), apolipoprotein B, and mortality rate between elderly sICH patients with different FFA levels (P<0.05). The log-rank test demonstrated that elderly sICH patients with different FFA levels exhibited significant differences in 90-day mortality risk (P<0.05). Univariate Cox proportional hazards regression analysis indicated that age, FFA, hematoma volume, NIHSS score, white blood cell count, hypertension, smoking, and APTT might be associated with 90-day all-cause mortality in elderly sICH patients (P<0.05). In the multivariate Cox proportional hazards regression model, after adjusting for hematoma volume, NIHSS score, APTT, white blood cell count, age, and diastolic blood pressure, FFA remained an independent influencing factor for 90-day all-cause mortality in elderly patients with sICH (HR=2.803, 95%CI: 1.032-7.611). Pearson correlation analysis indicated a positive correlation between FFA level and hematoma volume (r=0.161, P<0.001). Mediation analysis revealed that the indirect effect of FFA on 90-day mortality through hematoma volume was 0.351 (95%CI: 0.123-0.663). Conclusions FFA level at admission is significantly associated with the 90-day mortality risk in elderly sICH patients, and it may influence the 90-day mortality through hematoma volume.

Key words: free fatty acids, spontaneous intracerebral hemorrhage, aged, risk factor, all-cause mortality

中图分类号:

R 743.3

任丽艳, 韩春茹, 孙璐, 马临庆. 游离脂肪酸与老年自发性脑出血患者90 d死亡风险的关联性[J]. 实用老年医学, 2026, 40(7): 697-702.

REN Liyan, HAN Chunru, SUN Lu, MA Linqing. Association of free fatty acids with 90-day mortality risk in elderly patients with spontaneous intracerebral hemorrhage[J]. Practical Geriatrics, 2026, 40(7): 697-702.

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