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中华脑血管病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 258 -265. doi: 10.3877/cma.j.issn.1673-9248.2026.03.004

论著

缺血性脑卒中患者的肌肉健康与类淋巴系统相关性
朱恩俊儒, 程畅, 贺玉琴, 姚笛, 郝嘉欢, 汪明欢†()   
  1. 430000　湖北武汉，华中科技大学同济医学院附属同济医院神经内科
  • 收稿日期:2026-02-16 出版日期:2026-06-01
  • 通信作者: 汪明欢
  • 基金资助:
    国家自然科学基金面上项目(82271355); 国家自然科学基金青年项目(82301509); 湖北省自然科学基金杰出青年人才项目(2022CFA097)

Correlation between muscle health and glymphatic system in ischemic stroke patients

Enjunru Zhu, Chang Cheng, Yuqin He, Di Yao, Jiahuan Hao, Minghuan Wang†()   

  1. Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
  • Received:2026-02-16 Published:2026-06-01
  • Corresponding author: Minghuan Wang
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引用本文：

朱恩俊儒, 程畅, 贺玉琴, 姚笛, 郝嘉欢, 汪明欢. 缺血性脑卒中患者的肌肉健康与类淋巴系统相关性[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(03): 258-265.

Enjunru Zhu, Chang Cheng, Yuqin He, Di Yao, Jiahuan Hao, Minghuan Wang. Correlation between muscle health and glymphatic system in ischemic stroke patients[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(03): 258-265.

目的

探讨肌肉健康对缺血性脑卒中和类淋巴系统（GS）的影响，并分析GS在二者之间的中介作用。

方法

基于英国生物银行数据库，纳入了首次采集影像时诊断为缺血性脑卒中[国际疾病分类（ICD）-10编码为G45和/或I63]的患者进行分析。收集所有患者的肌肉健康状况（包括步速和握力），并利用患者的弥散磁共振成像提取沿血管周围空间弥散张量成像（DTI-ALPS）指数，包括前部（aALPS）、中部（mALPS）、后部（pALPS）及平均指数（tALPS）。步速按照患者自我报告分为慢步速组、平稳步速组和快步速组。握力按照绝对握力和相对握力的三分位数分为低等握力组、中等握力组和高等握力组。采用Logistic回归分析确定步速、握力与缺血性脑卒中风险的关联，采用多元线性回归分析其与DTI-ALPS的关联，并运用因果中介分析框架检验DTI-ALPS的中介效应。

结果

本研究共纳入37 370例同时包含握力、步速和DTI-ALPS指数数据的缺血性脑卒中患者。慢步速是缺血性脑卒中的危险因素（OR=1.577，95%CI：1.186~2.070，P=0.001），高等绝对握力是缺血性脑卒中的保护因素（OR=0.774，95%CI：0.628~0.952，P=0.016），而相对握力对缺血性脑卒中的发生风险无显著影响（OR=0.819~0.871，P均＞0.05）。与平稳步速组患者相比，慢步速组患者的所有DTI-ALPS指数均显著降低（β值：-0.037~-0.025，P均＜0.001），快步速组患者的所有DTI-ALPS指数均显著升高（β值：0.009~0.012，P均＜0.001）。相较于低等绝对握力组患者，中等绝对握力组患者的所有DTI-ALPS指数均有所上升（β值：0.010~0.013，P均＜0.001），高等绝对握力组患者的所有DTI-ALPS指数升高幅度更为明显（β值：0.015~0.020，P均＜0.001）。Logistic回归分析结果显示：DTI-ALPS指数增高，缺血性脑卒中发生的风险均显著降低（aALPS：OR=0.577，P=0.011；mALPS：OR=0.631，P=0.015；pALPS：OR=0.574，P=0.016；tALPS：OR=0.526，P=0.006），其中，tALPS指数最为显著。中介分析结果显示：所有DTI-ALPS指数都部分中介了慢步速（中介比例2.19%~3.11%）和高等绝对握力（中介比例3.60%~4.80%）与缺血性脑卒中的关联。

结论

良好的肌肉功能（即步速快、握力强）人群的GS功能更好，缺血性脑卒中发生风险低。通过改善缺血性脑卒中患者的肌肉健康状况，可以调控患者的GS功能，从而降低脑卒中的发生风险。

关键词: 类淋巴系统, 沿血管周围空间弥散张量成像, 步速, 握力, 缺血性脑卒中
Objective

To investigate the effects of muscle health on ischemic stroke and the glymphatic system (GS), and to analyze the mediating role of the GS between the two.

Methods

Based on data from the UK Biobank, patients diagnosed with ischemic stroke [International Classification of Diseases, Tenth Revision (ICD-10) codes G45 and/or I63] at the time of first imaging acquisition were included in the analysis. Muscle health measures (walking pace and grip strength) were collected for all participants. The diffusion tensor imaging along the perivascular space (DTI-ALPS) index was derived from diffusion-weighted magnetic resonance imaging, including anterior (aALPS), middle (mALPS), posterior (pALPS), and total (tALPS) indices. Walking pace was self-reported and categorized into slow, steady, and fast pace groups. Grip strength was divided into tertiles based on absolute and relative values, resulting in low, medium, and high grip strength groups. Logistic regression was used to analyze the association of walking pace and grip strength with ischemic stroke risk, while multivariate linear regression assessed their association with the DTI-ALPS index. A causal mediation analysis framework was applied to examine the mediating effect of the DTI-ALPS index.

Results

This study included a total of 37 370 ischemic stroke patients with data on grip strength, walking pace, and DTI-ALPS index. Slow walking pace was a risk factor for ischemic stroke (OR=1.577, 95%CI: 1.186 – 2.070, P=0.001), while high absolute grip strength was a protective factor (OR=0.774, 95%CI: 0.628 – 0.952, P=0.016). In contrast, relative grip strength showed no significant effect on the risk of ischemic stroke (OR=0.819 – 0.871, both P＞0.05). Compared with the steady pace group, the slow pace group showed a decrease in all DTI-ALPS indices (β: -0.037 – -0.025, all P＜0.001), while the fast pace group showed an increase in all DTI-ALPS indices (β: 0.009 – 0.012, all P＜0.001). Relative to the low absolute grip strength group, the medium absolute grip strength group exhibited increased DTI-ALPS indices (β: 0.010 – 0.013, all P＜0.001), and the high absolute grip strength group demonstrated even greater increases (β: 0.015 – 0.020, all P＜0.001). Logistic regression analysis revealed that higher DTI-ALPS indices were associated with significantly lower risk of ischemic stroke (aALPS: OR=0.577, P=0.011; mALPS: OR=0.631, P=0.015; pALPS: OR=0.574, P=0.016; tALPS: OR=0.526, P=0.006), with the tALPS index being the most significant. Mediation analysis revealed that all DTI-ALPS indices partially mediated the association of ischemic stroke with slow walking pace (mediation proportion: 2.19% – 3.11%) and high absolute grip strength (mediation proportion: 3.60% – 4.80%) with ischemic stroke.

Conclusion

Individuals with better muscle function, characterized by faster walking pace and stronger grip strength, exhibited improved GS function and a lower risk of ischemic stroke. Improving muscle health in patients with ischemic stroke may help regulate GS function, thereby reducing the risk of stroke occurrence.

Key words: Glymphatic system, Diffusion tensor imaging along the perivascular space, Walking pace, Grip strength, Ischemic stroke
图1 缺血性脑卒中研究人群筛选流程图 注：DTI-ALPS为沿血管周围空间弥散张量成像
表1 37 370例缺血性脑卒中患者的人口学特征和核心变量描述
项目 数值
年龄（岁，
±s）		 64.05±7.67
男性[例（%）] 17 553（46.97）
白人种族[例（%）] 36 308（97.16）
Townsend剥夺指数（
±s）		 -1.90±2.71
BMI（kg/m2，
±s）		 25.87±4.27
吸烟状态[例（%）]
从不 23 434（62.71）
以前吸烟 12 684（33.94）
当前吸烟 1252（3.35）
饮酒状态[例（%）]
从不 1192（3.19）
以前饮酒 1246（3.33）
当前饮酒 34 932（93.48）
疾病史[例（%）]
高血压 10 825（28.97）
糖尿病 1823（4.88）
高脂血症 7798（20.87）
心脏病 5209（13.94）
步速分组[例（%）]
平稳步速 18 676（49.98）
慢步速 1700（4.55）
快步速 16 994（45.47）
绝对握力值分组[例（%）]
低等握力 11 891（31.82）
中等握力 11 829（31.65）
高等握力 13 650（36.53）
相对握力值分组[例（%）]
低等握力 12 287（32.88）
中等握力 12 600（33.72）
高等握力 12 483（33.40）
DTI-ALPS指数
aALPS 1.69±0.20
mALPS 1.40±0.25
pALPS 1.20±0.21
tALPS 1.43±0.20
新发缺血性脑卒中[例（%）] 651（1.74）
表2 步速和握力与缺血性脑卒中的Logistic回归分析结果
变量 OR值 P值 95%CI
步速-慢步速 1.577 0.001 1.186~2.070
步速-快步速 0.964 0.678 0.808~1.147
绝对握力-中等 0.846 0.077 0.703~1.017
绝对握力-高等 0.774 0.016 0.628~0.952
相对握力-中等 0.871 0.158 0.718~1.055
相对握力-高等 0.819 0.087 0.651~1.029
图2 步速和握力与沿血管周围空间弥散张量成像（DTI-ALPS）指数的Logistic回归分析结果 注：所有模型均调整年龄、性别、种族、Townsend剥夺指数、体质量指数、吸烟、饮酒、高血压、糖尿病、高脂血症、心脏病史。β系数代表暴露变量每改变1个单位DTI-ALPS指数的变化量；aALPS为前部DTI-ALPS指数；mALPS为中部DTI-ALPS指数；pALPS为后部DTI-ALPS指数；tALPS为平均DTI-ALPS指数
表3 DTI-ALPS指数与缺血性脑卒中的Logistic回归分析结果
变量 OR值 P值 95%CI
aALPS 0.577 0.011 0.378~0.882
mALPS 0.631 0.015 0.434~0.915
pALPS 0.574 0.016 0.365~0.899
tALPS 0.526 0.006 0.332~0.832
图3 沿血管周围空间弥散张量成像（DTI-ALPS）指数在步速和握力与缺血性脑卒中风险中的中介作用。图a~d分别为前部DTI-ALPS指数（aALPS）、中部DTI-ALPS指数（mALPS）、后部DTI-ALPS指数（pALPS）、平均DTI-ALPS指数（tALPS）在慢步速组与缺血性脑卒中风险的中介效应；图e~h分别为aALPS、mALPS、pALPS、tALPS指数在高绝对握力组与缺血性脑卒中风险的中介效应 注：所有模型均调整年龄、性别、种族、Townsend剥夺指数、BMI、吸烟、饮酒、高血压、糖尿病、高脂血症、心脏病史。c=c'+a×b，c为总效应，c'为直接效应，a×b为间接效应。因变量为二分类变量，中介分析基于反事实框架（Logistic回归模型），直接效应与间接效应通过平均直接效应与平均因果中介效应进行估计，所有效应量均通过Bootstrap法（重复1000次）计算95%置信区间；总效应通过单独模型估算
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