臨床検査68巻5号

2024年05月発行

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今月の特集 肥満と健康障害 肥満と健康障害

肥満と脳血管疾患

著者： 山城一雄¹ 卜部貴夫¹

所属機関： ¹順天堂大学医学部附属浦安病院脳神経内科

ページ範囲：P.608 - P.613

Point

●肥満およびメタボリックシンドロームにより，脳卒中の発症リスクが上昇する．

●内臓脂肪型肥満は，アディポカイン分泌の調節不全により動脈硬化の原因となる．

●腸内細菌による炎症は，肥満と脳梗塞の病態に関与する可能性が示されている．

●脳卒中発症予防のため，肥満においては体重の適正化が推奨される．

参考文献

1）厚生労働省：2022年　国民生活基礎調査の概況（https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa22/）（最終アクセス：2024年1月23日）

2）Hata J, Ninomiya T, Hirakawa Y, et al：Secular trends in cardiovascular disease and its risk factors in Japanese: half-century data from the Hisayama Study (1961-2009). Circulation　128：1198-1205，2013

3）Ni Mhurchu C, Rodgers A, Pan WH, et al：Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants. Int J Epidemiol　33：751-758，2004

4）Yatsuya H, Toyoshima H, Yamagishi K, et al：Body mass index and risk of stroke and myocardial infarction in a relatively lean population: meta-analysis of 16 Japanese cohorts using individual data. Circ Cardiovasc Qual Outcomes　3：498-505，2010

5）Bodenant M, Kuulasmaa K, Wagner A, et al：Measures of abdominal adiposity and the risk of stroke: the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) study. Stroke　42：2872-2877，2011

6）Mo J, Chen Z, Xu J, et al：Efficacy of Clopidogrel-Aspirin Therapy for Stroke Does Not Exist in CYP2C19 Loss-of-Function Allele Noncarriers With Overweight/Obesity. Stroke　51：224-231，2020

7）Ninomiya T, Kubo M, Doi Y, et al：Impact of metabolic syndrome on the development of cardiovascular disease in a general Japanese population: the Hisayama study. Stroke　38：2063-2069，2007

8）Zhang F, Liu L, Zhang C, et al：Association of Metabolic Syndrome and Its Components With Risk of Stroke Recurrence and Mortality: A Meta-analysis. Neurology　97：e695-e705，2021

9）Vemmos K, Ntaios G, Spengos K, et al：Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox. Stroke　42：30-36，2011

10）Towfighi A, Ovbiagele B：The impact of body mass index on mortality after stroke. Stroke　40：2704-2708，2009

11）Dehlendorff C, Andersen KK, Olsen TS：Body mass index and death by stroke: no obesity paradox. JAMA Neurol　71：978-984，2014

12）Yamashiro K, Tanaka R, Tanaka Y, et al：Visceral fat accumulation is associated with cerebral small vessel disease. Eur J Neurol　21：667-673，2014

13）Ouchi N, Parker JL, Lugus JJ, et al：Adipokines in inflammation and metabolic disease. Nat Rev Immunol　11：85-97，2011

14）Lampe L, Zhang R, Beyer F, et al：Visceral obesity relates to deep white matter hyperintensities via inflammation. Ann Neurol　85：194-203，2019

15）Samara A, Murphy T, Strain J, et al：Neuroinflammation and White Matter Alterations in Obesity Assessed by Diffusion Basis Spectrum Imaging. Front Hum Neurosci　13：464，2019

16）Cox AJ, West NP, Cripps AW：Obesity, inflammation, and the gut microbiota. Lancet Diabetes Endocrinol　3：207-215，2015

17）Kurita N, Yamashiro K, Kuroki T, et al：Metabolic endotoxemia promotes neuroinflammation after focal cerebral ischemia. J Cereb Blood Flow Metab　40：2505-2520，2020

18）Klimiec E, Pera J, Chrzanowska-Wasko J, et al：Plasma endotoxin activity rises during ischemic stroke and is associated with worse short-term outcome. J Neuroimmunol　297：76-80，2016

19）Huang Q, Wei M, Feng X, et al：Hemorrhagic transformation in patients with large-artery atherosclerotic stroke is associated with the gut microbiota and lipopolysaccharide. Neural Regen Res　19：1532-1540，2024

20）Inaba T, Yamashiro K, Kurita N, et al：Microbial lipopolysaccharide-induced inflammation contributes to cognitive impairment and white matter lesion progression in diet-induced obese mice with chronic cerebral hypoperfusion. CNS Neurosci Ther　29（Suppl 1）：200-212，2023

21）Saji N, Saito Y, Yamashita T, et al：Relationship Between Plasma Lipopolysaccharides, Gut Microbiota, and Dementia: A Cross-Sectional Study. J Alzheimers Dis　86：1947-1957，2022

22）Zhan X, Stamova B, Jin LW, et al：Gram-negative bacterial molecules associate with Alzheimer disease pathology. Neurology　87：2324-2332，2016

23）日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2021 改訂2023，協和企画，2023

24）Festi D, Schiumerini R, Eusebi LH, et al：Gut microbiota and metabolic syndrome. World J Gastroenterol　20：16079-16094，2014