肥胖对无糖尿病合并症的急性冠脉综合征长期预后的影响

Effect of obesity on long-term prognosis in non-diabetic patients with acute coronary syndrome

目的分析肥胖因素对无糖尿病合并症的急性冠脉综合征（ACS）患者长期预后的影响。方法将571例诊断为ACS但无糖尿病的患者纳入研究,按体重指数（BMI）等级分为体重正常组（n=189）、超重组（n=266）和肥胖组（n=116）。对所有研究对象展开平均3年的出院后随访,随访终点事件为主要不良心血管事件（MACE）,包括主要终点事件（心源性死亡和非致死性心肌梗死）和因不稳定型心绞痛而再次入院治疗。结果 3年随访期间有33.6%的患者发生了MACE。随着BMI等级的增加,MACE发生率逐渐降低（P=0.031）。与体重正常组相比,肥胖组3年内发生MACE的风险更低（HR=0.58,95%CI 0.37-0.91,P=0.016）;在校正多种因素后,肥胖组仍具有较低的MACE发生风险（HR=0.60,95%CI 0.39-0.94,P=0.027）。结论在患有ACS但无糖尿病的患者中,肥胖者发生长期不良心血管事件的风险比体重正常者更低,该结果与对糖尿病患者、冠心病患者的研究结果一致。肥胖因素对患有ACS但无糖尿病患者的长期预后有保护作用。

Objective To evaluate the effect of obesity on long-term prognosis in patients with acute coronary syndrome（ACS） but without diabetes.Methods A total of 571 patients with ACS but without diabetes were included in a retrospective study.The patients were categorized as normal,overweight,and obese groups based on body mass index（BMI） levels.The mean follow-up time was 3 years.The ultimate events were major adverse cardiovascular events（MACE）,including primary ultimate events（sudden cardiac death and non-fatal myocardial infarction） and rehospitalization with unstable angina.Results The incidence of long-term MACE was 33.6%,and it decreased with the increase in BMI levels（P trend=0.031）.Obese patients had a lower risk of MACE than their normal weight counterparts（HR=0.58;95% CI,0.37-0.91;P=0.016）.After multivariable adjustment,the lower risk of MACE in obese patients remained significant（HR=0.60;95% CI,0.39-0.94;P=0.027）.Conclusions In a population with ACS but without diabetes,obese patients had a decreased risk of cardiovascular events compared with normal weight patients.In concordance with the data in patients with diabetes or coronary heart disease,the present study has further suggested that obesity may play a protective effect on long-term prognosis in patients with ACS but without diabetes.