南方医科大学学报

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (2): 239-246.doi: 10.12122/j.issn.1673-4254.2026.02.01

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基于生命八要素的心血管健康评分与缺血性脑卒中预后相关性及临床检验指标的中介效应：一项多中心前瞻性队列研究

梁笑笑1(), 栾慧林1, 马鹏珍2, 邓文珠1, 金佳欣1, 全晨阳1, 陈婷婷3, 杨友财1, 谢颖桢1()   

  1. 1.北京中医药大学东直门医院，北京 100700
    2.中国中医科学院中医药数据中心，北京 100700
    3.北京中医药大学房山医院，北京 102400
  • 收稿日期:2025-06-10 出版日期:2026-02-20 发布日期:2026-03-10
  • 通讯作者: 谢颖桢 E-mail:lxx13286242364@163.com;xyz_3191@aliyun.com
  • 作者简介:梁笑笑，在读博士研究生，E-mail: lxx13286242364@163.com
  • 基金资助:
    国家重点研发计划(2017YFC1700101)

Correlation between cardiovascular health score based on eight life factors and prognosis of ischemic stroke and mediating effect of clinical test indicators: a multicenter prospective cohort study

Xiaoxiao LIANG1(), Huilin LUAN1, Pengzhen MA2, Wenzhu DENG1, Jiaxin JIN1, Chenyang QUAN1, Tingting CHEN3, Youcai YANG1, Yingzhen XIE1()   

  1. 1.Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
    2.Traditional Chinese Medicine Data Center, China Academy of Traditional Chinese Medicine, Beijing 100700, China
    3.Fangshan Hospital, Beijing University of Chinese Medicine, Beijing 102400, China
  • Received:2025-06-10 Online:2026-02-20 Published:2026-03-10
  • Contact: Yingzhen XIE E-mail:lxx13286242364@163.com;xyz_3191@aliyun.com

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摘要：

目的 探讨基于生命八要素（LE8）的心血管健康评分对急性缺血性脑卒中（AIS）患者90 d功能预后的影响，探究相关实验室指标在其中的中介作用。 方法 采用多中心前瞻性队列研究设计，纳入发病72 h内的急性缺血性脑卒中患者。收集患者临床资料，依据美国心脏协会定义的LE8标准计算心血管健康评分。通过电话随访及评估患者发病后90 d的功能预后。及改良Rankin量表（mRS）评分。应用多重线性回归分析LE8总评分及各单项评分与90 d mRS评分的关系。采用Lasso回归筛选与90 d mRS评分相关的实验室指标，并通过Bootstrap法进行中介效应分析，探究筛选出的指标在LE8评分与卒中预后关系中的中介作用。 结果 共纳入599例患者，校正混杂因素后，LE8总评分与90 d mRS评分呈负相关（β=-0.05，95% CI：-0.06，-0.041，P<0.001）；LE8各单项评分：运动、饮食质量、尼古丁暴露、睡眠、体质量指数、胆固醇、血压均与90 d mRS评分呈负相关（P<0.05）。影响90 d mRS的检验指标中，纤维蛋白原（FIB）水平（β=0.215；95% CI：0.068，0.361；P=0.0041）与90 d mRS评分呈正相关，MCHC（β=-0.012；95% CI：-0.022，-0.002；P=0.0229）及HRR（β=-0.007；95% CI：-0.013，0.00；P=0.042）与90 d mRS评分呈负相关。中介效应分析显示，FIB在 LE8评分与90 d mRS评分的关系中起显著中介作用，间接效应为-0.0019（95% CI：-0.00381，0.00，P=0.006），中介效应比例为3.778%（95% CI：0.00869，0.08）。 结论 基于LE8评分的心血管健康评分与AIS患者90 d功能预后呈负相关，提示维持良好的心血管健康水平对改善卒中预后至关重要。血凝及炎症相关指标FIB及红细胞参数MCHC、HRR与预后不良相关，其中FIB在LE8评分影响卒中预后的过程中发挥部分中介作用，为卒中二级预防提供依据。

关键词: 生命八要素, 心血管健康评分, 急性缺血性脑卒中, 预后, 中介效应

Abstract:

Objective To investigate the association between cardiovascular health scores (CVH) based on Life's Essential 8 (LE8) and 90-day functional prognosis of patients with acute ischemic stroke (AIS) and explore the mediating role of laboratory indicators to provide evidence for secondary stroke prevention. Methods This multicenter, prospective cohort study was conducted among 599 AIS patients within 72 h of onset. The clinical data of the patients were collected, and the cardiovascular health (CVH) scores were calculated according to LE8 criteria. Functional prognosis of the patients at 90 days were assessed by telephone follow-up using the modified Rankin scale score (mRS), whose correlation with the total LE8 score and each individual item score were analyzed using multiple linear regression. Lasso regression analysis was used to select laboratory markers associated with 90-day mRS, and their mediating role in the LE8-outcome relationship were assessed using the Bootstrap method. Results After adjusting for confounders, the total LE8 score was found to inversely correlate with 90-day mRS score of the patients (β=-0.05, 95% CI: -0.06‒-0.041; P<0.001). The scores of 7 LE8 components (exercise, diet quality, nicotine exposure, sleep, body mass index, cholesterol, and blood pressure) were inversely correlated with 90-day mRS scores (all P<0.05). Among the laboratory parameters, fibrinogen (FIB) was positively correlated (β=0.215, 95% CI: 0.068‒0.361; P=0.0041) while MCHC (β=-0.012, 95% CI: -0.022‒-0.002; P=0.0229) and HRR (β=-0.007, 95% CI: -0.013‒0.00; P=0.042) were negatively correlated with 90-day mRS scores. FIB significantly mediated the relationship between LE8 scores and 90-day mRS scores with an indirect effect of -0.0019 (95% CI: -0.00381‒0.00; P=0.006) and a mediation proportion of 3.778% (95% CI: 0.00869‒0.08). Conclusion The CVH scores assessed by LE8 are inversely correlated with 90-day functional prognosis of AIS patients, suggesting the importance of maintaining good CVH for improving stroke outcomes. FIB, MCHC and HRR levels are inversely correlated with the patient prognosis, and FIB partially mediates the impact of LE8 scores on stroke outcomes.

Key words: Life's Essential 8, cardiovascular health score, acute ischemic stroke, prognosis, mediating effect