临床荟萃 ›› 2024, Vol. 39 ›› Issue (11): 1040-1046.doi: 10.3969/j.issn.1004-583X.2024.11.013
朱静, 黄灿(
)
收稿日期:2024-07-03
出版日期:2024-11-20
发布日期:2024-12-04
通讯作者:
黄灿
E-mail:15905829@qq.com
基金资助:
Received:2024-07-03
Online:2024-11-20
Published:2024-12-04
摘要：
缺血性卒中具有高发病率、高致残率、高病死率及高复发率等特点,尽早开始二级预防对降低卒中复发至关重要。通过改善饮食、增加体育锻炼和戒烟限酒等措施干预缺血性卒中的危险因素,对预防卒中复发同样重要。目前已有大量专门针对抗栓、降脂、降压和降糖进行干预的高质量大型二级预防临床研究为缺血性卒中的临床诊疗提供了循证医学证据。但缺少可靠证据证实改善饮食可降低缺血性卒中的复发风险。本文从特定营养素、特定食品、食物类别和饮食模式四个方面对饮食与复发性缺血性卒中的二级预防展开论述,旨在为临床提供一定参考。
中图分类号:
朱静, 黄灿. 饮食与复发性缺血性卒中二级预防的研究进展[J]. 临床荟萃, 2024, 39(11): 1040-1046.
| 饮食干预 | 纳入的研究类型 | 参与者 | 研究结果 |
|---|---|---|---|
| 特定营养素 | |||
| 叶酸、维生素B6、维生素B12[ | 随机对照试验 | 既往卒中或短暂性脑缺血发作( | 未降低卒中复发率 |
| 维生素B12[ | 队列研究 | 23 119例男性和35 611例女性,年龄40~79岁 | 与脑卒中复发率无关 |
| 叶酸[ | 队列研究 | 26 556例男性吸烟者 | 与脑卒中发病率呈负相关 |
| 维生素C[ | 队列研究 | 217 454例正常健康者和3 762例脑卒中患者 | 与脑卒中呈负相关 |
| 维生素A、维生素E、维生素C[ | 随机对照试验 | 188 209例正常健康者和3 749例脑卒中患者 | 与降低缺血性脑卒中及心血管事件无相关性 |
| 维生素D、Omega-3脂肪酸[ | 队列研究 | 成年人群 | 无相关性 |
| ω-3脂肪酸[ | 队列研究 | 平均年龄73岁的老年人,36%男性 | 与脑卒中呈负相关 |
| 钙、镁[ | 前瞻性研究 | 平均年龄66岁的老年人 | 较高的钙、镁摄入量是有益的 |
| 盐[ | 随机对照试验 | 12 197例平均年龄在23~73岁的成年人 | 降低氯化钠摄入量可以降低血压 |
| 盐[ | 随机对照试验 | 20 996例平均年龄大于60岁的成年人(患有高血压) | 减少钠摄入量对降低复发性卒中发病率有直接影响 |
| 盐(2 645~4 945 mg/d)[ | 队列研究和随机对照试验 | 平均年龄65岁以上的老年人(患有高血压) | 2 645~4 945 mg/d钠盐摄入不会增加心血管疾病风险 |
| 特定食品 | |||
| 鸡蛋[ | 随机对照试验 | 糖尿病患者 | 糖尿病患者冠状动脉粥样硬化风险增加 |
| 酒精[ | 队列研究 | 年龄为40~75岁的38 156例美国男性 | 中度和重度饮酒增加了脑卒中发病风险 |
| 酒精[ | 队列研究 | 19 544例日本男性 | 大量饮酒(每周>450 g乙醇)显著增加了脑出血的发病风险,轻度酒精的摄入并不会增加脑卒中的发病风险 |
| 酒精[ | 队列研究 | 美国老年人群 | 每周喝1~6杯酒(1杯=45 ml,相当于14 g乙醇)对缺血性卒中有适度保护作用 |
| 饮料[ | 前瞻性研究 | 白种人人群 | 摄入含糖饮料与卒中发病风险呈正相关 |
| 坚果[ | 队列研究 | 16 217例年龄30~75岁的糖尿病患者 | 食用坚果与中风发病率无相关性 |
| 坚果[ | 随机对照试验和队列研究 | 155 685例正常健康者和5 544个卒中事件 | 坚果摄入量与卒中无关联 |
| 坚果[ | 前瞻性研究 | 平均年龄20~50岁的成年人 | 女性摄入的坚果越多,卒中风险越小 |
| 咖啡[ | 前瞻性研究 | 年龄在25~65岁的成年人 | 每天饮用1.5杯咖啡和3杯咖啡,脑卒中发病风险可分别降低11%和20% |
| 茶[ | 前瞻性研究 | 成年人 | 每天喝1~3杯绿茶的人比每天喝<1杯绿茶的人卒中风险下降36% |
| 特定食品 | |||
| 肉类[ | 队列研究 | 成年糖尿病患者(平均年龄59岁) | 肉类摄入量(最少为每天10 g,最多为每天98 g)与卒中发病率无相关性 |
| 鱼类[ | 前瞻性队列研究 | 平均年龄在64岁的患有糖尿病的人群 | 每周增加摄入3份或3份以上的鱼,卒中发病率减少了6% |
| 鱼类[ | 队列研究 | 美国1 136例糖尿病成年人 | 鱼摄入量每周超过两份,可使卒中病死率降低70% |
| 谷物[ | 前瞻性研究 | 208 143例正常健康者 | 全谷物摄入可降低卒中事件发生率 |
| 谷物[ | 前瞻性研究 | 410 821例正常健康者和8 284例卒中事件 | 精制谷物摄入量与卒中风险无关 |
| 饮食模式 | |||
| 低脂饮食[ | 病例对照研究 | 1 656例存在心血管疾病的女性,19 984例存在高血压病的女性 | 两组卒中风险差异无统计学意义 |
| 低脂饮食[ | 队列研究 | 50 952例健康成年人 | 限制饱和脂肪酸的摄入并未改善脑卒中发病风险 |
| 地中海式饮食[ | 随机对照试验 | 7 447例患心血管疾病的男性和女性(平均年龄67岁) | 地中海饮食辅以坚果降低了卒中发病次数 |
| 地中海式饮食[ | 队列研究 | 79 287例接受地中海风格饮食的成年糖尿病人群 | 脑卒中的风险降低了20% |
| 预防高血压的饮食[ | 随机对照试验 | 1 730例平均年龄在24~71岁的患有高血压或高血压前期的成年人 | 同时降低收缩压和舒张压的最有效饮食 |
| 植物性饮食[ | 前瞻性队列研究 | 患有高血压、糖尿病的成年人 | 增加水果和蔬菜的消费可减少脑卒中发病风险 |
表1 缺血性卒中风险人群的饮食干预研究总结
| 饮食干预 | 纳入的研究类型 | 参与者 | 研究结果 |
|---|---|---|---|
| 特定营养素 | |||
| 叶酸、维生素B6、维生素B12[ | 随机对照试验 | 既往卒中或短暂性脑缺血发作( | 未降低卒中复发率 |
| 维生素B12[ | 队列研究 | 23 119例男性和35 611例女性,年龄40~79岁 | 与脑卒中复发率无关 |
| 叶酸[ | 队列研究 | 26 556例男性吸烟者 | 与脑卒中发病率呈负相关 |
| 维生素C[ | 队列研究 | 217 454例正常健康者和3 762例脑卒中患者 | 与脑卒中呈负相关 |
| 维生素A、维生素E、维生素C[ | 随机对照试验 | 188 209例正常健康者和3 749例脑卒中患者 | 与降低缺血性脑卒中及心血管事件无相关性 |
| 维生素D、Omega-3脂肪酸[ | 队列研究 | 成年人群 | 无相关性 |
| ω-3脂肪酸[ | 队列研究 | 平均年龄73岁的老年人,36%男性 | 与脑卒中呈负相关 |
| 钙、镁[ | 前瞻性研究 | 平均年龄66岁的老年人 | 较高的钙、镁摄入量是有益的 |
| 盐[ | 随机对照试验 | 12 197例平均年龄在23~73岁的成年人 | 降低氯化钠摄入量可以降低血压 |
| 盐[ | 随机对照试验 | 20 996例平均年龄大于60岁的成年人(患有高血压) | 减少钠摄入量对降低复发性卒中发病率有直接影响 |
| 盐(2 645~4 945 mg/d)[ | 队列研究和随机对照试验 | 平均年龄65岁以上的老年人(患有高血压) | 2 645~4 945 mg/d钠盐摄入不会增加心血管疾病风险 |
| 特定食品 | |||
| 鸡蛋[ | 随机对照试验 | 糖尿病患者 | 糖尿病患者冠状动脉粥样硬化风险增加 |
| 酒精[ | 队列研究 | 年龄为40~75岁的38 156例美国男性 | 中度和重度饮酒增加了脑卒中发病风险 |
| 酒精[ | 队列研究 | 19 544例日本男性 | 大量饮酒(每周>450 g乙醇)显著增加了脑出血的发病风险,轻度酒精的摄入并不会增加脑卒中的发病风险 |
| 酒精[ | 队列研究 | 美国老年人群 | 每周喝1~6杯酒(1杯=45 ml,相当于14 g乙醇)对缺血性卒中有适度保护作用 |
| 饮料[ | 前瞻性研究 | 白种人人群 | 摄入含糖饮料与卒中发病风险呈正相关 |
| 坚果[ | 队列研究 | 16 217例年龄30~75岁的糖尿病患者 | 食用坚果与中风发病率无相关性 |
| 坚果[ | 随机对照试验和队列研究 | 155 685例正常健康者和5 544个卒中事件 | 坚果摄入量与卒中无关联 |
| 坚果[ | 前瞻性研究 | 平均年龄20~50岁的成年人 | 女性摄入的坚果越多,卒中风险越小 |
| 咖啡[ | 前瞻性研究 | 年龄在25~65岁的成年人 | 每天饮用1.5杯咖啡和3杯咖啡,脑卒中发病风险可分别降低11%和20% |
| 茶[ | 前瞻性研究 | 成年人 | 每天喝1~3杯绿茶的人比每天喝<1杯绿茶的人卒中风险下降36% |
| 特定食品 | |||
| 肉类[ | 队列研究 | 成年糖尿病患者(平均年龄59岁) | 肉类摄入量(最少为每天10 g,最多为每天98 g)与卒中发病率无相关性 |
| 鱼类[ | 前瞻性队列研究 | 平均年龄在64岁的患有糖尿病的人群 | 每周增加摄入3份或3份以上的鱼,卒中发病率减少了6% |
| 鱼类[ | 队列研究 | 美国1 136例糖尿病成年人 | 鱼摄入量每周超过两份,可使卒中病死率降低70% |
| 谷物[ | 前瞻性研究 | 208 143例正常健康者 | 全谷物摄入可降低卒中事件发生率 |
| 谷物[ | 前瞻性研究 | 410 821例正常健康者和8 284例卒中事件 | 精制谷物摄入量与卒中风险无关 |
| 饮食模式 | |||
| 低脂饮食[ | 病例对照研究 | 1 656例存在心血管疾病的女性,19 984例存在高血压病的女性 | 两组卒中风险差异无统计学意义 |
| 低脂饮食[ | 队列研究 | 50 952例健康成年人 | 限制饱和脂肪酸的摄入并未改善脑卒中发病风险 |
| 地中海式饮食[ | 随机对照试验 | 7 447例患心血管疾病的男性和女性(平均年龄67岁) | 地中海饮食辅以坚果降低了卒中发病次数 |
| 地中海式饮食[ | 队列研究 | 79 287例接受地中海风格饮食的成年糖尿病人群 | 脑卒中的风险降低了20% |
| 预防高血压的饮食[ | 随机对照试验 | 1 730例平均年龄在24~71岁的患有高血压或高血压前期的成年人 | 同时降低收缩压和舒张压的最有效饮食 |
| 植物性饮食[ | 前瞻性队列研究 | 患有高血压、糖尿病的成年人 | 增加水果和蔬菜的消费可减少脑卒中发病风险 |
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