体质指数与收缩性心力衰竭预后的相关性

Body mass index and prognosis in patients with systolic heart failure

目的在没有心血管疾病的正常人群中，超重和肥胖会增加死亡风险。然而，某些慢性疾病患者，低体质指数（BMI）与病死率增加相关。研究旨在探讨BMI对收缩性心力衰竭（心衰）患者预后的影响。方法对540例经超声心动图证实左室射血分数≤45％的陈旧性心肌梗死和扩张型心肌病患者进行随访，平均年龄58．53岁，其中男性84．2％。结果在随访期间（中位随访时间24个月），共有92例死亡，其中87例患者心原性死亡，92例因心衰再次入院。与BMI≥28．0kg／m^2肥胖的收缩性心衰患者比较，低体重（BMI〈18．5kg／m^2）和正常体重（BMI≥18．5kg／m^2、〈24．0kg／m^2）收缩性心衰患者全因病死率、心原性病死率、心衰病死率和总心脏事件率均显著升高（均为P〈0．05），OR（95％ CI）分别是5．44（1．78～16．66）、4．30（1．71～10．82），5．42（1．77～16．59）、4．00（1．59—10．10），8．94（2．37—33．74）、4．97（1．52—16．20），2．10（1．09～4．07）、1．79（1．14～2．82）。多元Cox回归校正年龄、性别、NYHA分级、左室射血分数值以后，BMI分组对收缩性心衰患者全因病死率（OR=0．77，P〈0．05）、心原性病死率（OR=0．78，P〈0．05）和心衰病死率（OR=0．79，P〈0．05）仍有显著影响。结论收缩性心衰患者BMI低是预后差的一个独立预测因素。在由陈旧性心肌梗死和扩张型心肌病所致的收缩性心衰患者中，与肥胖患者相比，极低体重和正常体重患者全因病死率、心原性病死率和心衰病死率较高。

Objective In individuals without cardiovascular disease, elevated body mass index （BMI） is associated with an increased risk of death. However, in patients with certain chronic diseases, including heart failure, low BMI has been associated with increased mortality. We investigated the association between BMI and prognosis in patients with systolic HF. Method Follow-up was made on 540 patients （mean age 58. 53 years, 84. 2% men） with systolic HF （LVEF≤45%） and association between BMI and adverse cardiac events was analyzed. Results During a median follow-up of 24 months, 92 patients died including 87 cases of cardiac death and 92 patients were rehospitalized. Compared with patients with BMI higher than 28.0 kg/m^2, patients in lower BMI categories （BMI≤18.5 kg/m^2 and ≥18.5 kg/m^2 〈24.0 kg/m^2） had a graded increase in the all cause death rate [5.44（1.78 -16.66）,4.30（1.71 - 10. 82） ], cardiac death rate [ OR（95 % CI） ： 5.42 （ 1.77 - 16. 59 ） ,4.00 （ 1.59 - 10. 10 ） ], HF death rate [8.94（2.37 -33.74）,4.97（1.52-16.20）] and MACE rate [2.10 （1.09 -4.07）,1.79 （1.14- 2. 82） ]. After adjustment for age, gender, LVEF and NYHA grade using cox regression analysis, BMI categories still significantly associated with all cause death rate （ OR = 0. 77, P 〈 0. 05 ）, cardiac death rate （ OR = 0. 78, P 〈 0. 05 ） and HF death rate （ OR = 0. 79, P 〈 0. 05 ）. Conclusion In patients with systolic heart failure, lower BMI was an independent predictor of increased all cause death rate, cardiac death rate and HF death rate.