临床研究综述:肥胖对心力衰竭的发展与转归的影响

The impact of obesity on the development and outcome of heart failure: a comprehensive review of relevant clinical researches

尽管既往一些研究提示,肥胖是导致心力衰竭(心衰)发生的危险因素,但也有越来越多的证据表明,体质量指数(BMI)增加与心衰患者的预后改善相关。这种看似矛盾的关系被称为"肥胖悖论"。本文将从肥胖与心衰发生发展的关系(尸体解剖证据及流行病学证据),肥胖导致心衰的可能机制(血流动力学机制和神经内分泌机制),肥胖对心衰预后的影响("肥胖悖论"的提出及可能解释)、肥胖与心衰关系的目前认识及未来研究方向的总结几个方面综述肥胖与心衰的关系。

Although some previous studies have shown that obesity is a risk factor for heart failure(HF),emgering evidences have suggested that increased body mass index is associated with improved prognosis in patients with HF.This seemingly contradictory relationship is termed as"obesity paradox".This article will review the relationship between obesity and HF from the aspects as follows,obesity and HF genesis and progression(the era of autopsy exploration and epidemiological studies),the pathophysiological mechanisms linking obesity to HF(hemodynamics and neurohumoral fluid),the impact of obesity on the prognosis in HF(the discovery of and possible explanation for"obesity paradox")and summary of current knowledge and possible future directions regarding the relationship between obesity and HF.