急性心肌梗死患者体重指数与院内死亡的关联研究

Relation between body mass index and in-hospital mortality in patients with acute myocardial infarction

目的 探讨急性心肌梗死患者不同体重指数(body mass index,BMI)水平与院内死亡的关联,并评估代谢和炎症在此关联中的作用。方法 纳入2017年1月至2022年12月首都医科大学宣武医院入院的急性心肌梗死患者,收集年龄、性别等临床资料,应用logistic回归模型,评估不同BMI水平与院内死亡的关联,进一步纳入代谢和炎症因素,评估其中介效应。结果 本研究共纳入2928例患者,其中男性2289例,女性639例;患者平均年龄为(63.2±12.5)岁。校正年龄、性别、吸烟、既往心肌梗死病史、心肌梗死类型、再灌注治疗、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、病变冠状动脉血管数量、肌钙蛋白Ⅰ峰值、左心室射血分数(left ventricular ejection fraction,LVEF)后,肥胖患者院内死亡风险高于正常体重患者,差异有统计学意义(OR=3.54,95%CI 1.30~9.63,P=0.01),超重患者与正常体重患者院内死亡风险差异无统计学意义。进一步校正代谢因素后结果和校正前一致,进一步校正高敏C反应蛋白后,肥胖患者与正常体重患者院内死亡风险差异不再有统计学意义。结论 本研究未能发现肥胖对急性心肌梗死患者的保护作用,相反,肥胖患者院内死亡风险较正常体重患者更高,应重视肥胖急性心肌梗死患者的管理,抗炎治疗对不同BMI水平急性心肌梗死患者的作用有待进一步研究。

Objective To explore the association between body mass index(BMI)and in-hospital mortality in patients with acute myocardial infarction and to evaluate the effect of metabolism and inflammation in the association.Methods The patients with acute myocardial infarction admitted to Xuanwu Hospital of Capital Medical University from January 2017 to December 2022 were included.The clinical data were collected and the logistic regression models were used to evaluate the association between different BMI levels and in-hospital mortality.The metabolic and inflammatory factors were further included to evaluate their mediating effects.Results Among 2928 patients,there were 2289 males and 639 females respevtively;the average age was(63.2±12.5)years.After adjusting for the age,gender,smoking status,previous myocardial infarction,type of myocardial infarction,reperfusion therapy,eGFR,number of stenotic coronary arteries,peak cardiac troponin I and left ventricular ejection fraction(LVEF),the obese patients had significantly higher in-hospital mortality risk than normal-weight patients(OR=3.54,95%CI 1.30-9.63,P=0.013)but there was no significant difference in in-hospital mortality risk between the overweight patients and normal-weight patients.After further adjustment for metabolic factors,the result was consistent with the prior result.But after further adjustment for high-sensitivity C-reactive protein,there was no significant difference in in-hospital mortality risk between the obese patients and normalweight patients.Conclusion Obese patients had a higher risk of in-hospital mortality than normal weight patients.Therefore,more attention should be paid to the management of obese patients with acute myocardial infarction.The effect of anti-inflammatory treatment on acute myocardial infarction patients with different BMI levels needs further research.