体重指数对冠状动脉旁路移植术患者预后的影响

Effect of body mass index on prognosis of patients undergoing coronary artery graft bypass

目的探讨体重指数对冠状动脉旁路移植术患者预后的影响。方法回顾性收集2012年6月113至9月1日于中国医学科学院阜外医院行首次单纯冠状动脉旁路移植术861例患者的临床资料，根据体重指数将所有患者分为正常体质量组（体重指数l8．5～23．9kg／m2，270例）、超重组（体重指数24．0～27．9kg／m2，422例）、肥胖组（体重指数28．0～32．0kg／m2，169例）。比较3组患者一般资料、初步血运重建后短期主要术后并发症发生率和病死率。采用多因素Cox回归模型对患者病死率的相关因素进行分析。结果正常体质量组患者年龄大于超重组和肥胖组[（62±9）岁比（61±8）、（59±9）岁]，肥胖组患者高血压、高脂血症发生比例高于正常体质量组和超重组[78．1％（132／169）比59．3％（160／270）、65．6％（277／422），71．0％（120／169）比61．9％（167／270）、62．3％（263／422）]，差异均有统计学意义（均P〈0．05）。3组患者围术期并发症发生率和病死率差异无统计学意义（P〉0．05）。Cox回归分析表明，肥胖组患者术后1年病死率明显低于正常体质量组，差异有统计学意义（P〈0．05），年龄、吸烟、心肌梗死和左心室射血分数与病死率无明显相关性（P〉0．05）。结论肥胖患者冠状动脉旁路移植术后1年病死率明显低于正常体质量患者，年龄、吸烟、心肌梗死、左心室射血分数与病死率无明显相关性。

Objective To investigate the effect of body mass index （BMI） on prognosis of patients under- going coronary artery graft bypass （CABG）. Methods Totally 861 patients who underwent GABG from June to September in 2012 were enrolled and were divided into normal weight group （ BMI 18.5-23.9 kg/m2 , 270 eases） , overweight group （BMI 24. 0-27.9 kg/m2, 422 cases） and obesity group （BMI 28.0-32. 0 kg/m2, 169 cases）. The general data, incidences of major complications in hospital and 1 year after operation, mortality were compared among groups. The factors of mortality were analyzed with Cox regression model. Results The age in normal weight group was significantly higher than that in overweight group and obese group[ （62±9） years vs （61 ±8）, （59 ± 9 ） years ] , the proportions of hypertension and hyperlipidemia in obese group were significantly higher than those in normal weight group and overweight group [78. 1% （132/169） vs 59.3% （160/270） , 65.6% （277/ 422） ; 71.0% （120/169） vs 61.9% （167/270） , 62. 3% （263/422） ] （P 〈0. 05）. Perioperative complications incidence and mortality had no statistical significance in three groups （ P 〉 0. 05 ）. Cox regression analysis showed that the mortality 1 year after operation in obese patients was significantly lower than that in normal weight （ P 〈 0. 05） ; the age, smoking, myocardial infarction and left ventricular ejection fraction had no obvious correlation with mortality （P 〉 0. 05 ）. Conclusions Mortality 1 year after operation in obese patients is significantly lower than that in normal weight patients after GABG. Age, smoking, myocardial infarction and left ventricular ejection fraction have no obvious correlation with mortality.