体重指数对择期经皮冠状动脉介入治疗术后全因死亡率的预测意义

Impact of body mass index on mortality in patients undergoing elective percutaneous coronary intervention

目的探讨体重指数(BMI)对择期经皮冠状动脉介入治疗(PCI)术后全因死亡率的影响。方法入选2009年7月至2011年9月接受择期PCI的患者2964例,将患者分为体重正常组(BMI<24.0 kg/m^2,810例)、超重组(24.0≤BMI<28.0 kg/m^2,1454例)、肥胖组(BMI≥28 kg/m^2,700例)。比较各组患者临床特点及术后全因死亡率的差异。结果体重正常组患者年龄大于超重组[(60.1±10.2)岁比(59.2±10.3)岁]和肥胖组[(60.1±10.2)岁比(57.2±11.4)岁],超重组患者年龄大于肥胖组[(59.2±10.3)岁比(57.2±11.4)岁],差异均有统计学意义(均P<0.017);体重正常组患者女性比例高于超重组(30.1%比21.9%),而肥胖组患者女性比例高于超重组(27.9%比21.9%),差异均有统计学意义(均P<0.017)。体重正常组患者高血压病、白细胞计数、血红蛋白、三酰甘油、空腹血糖、前降支近端病变比例等小于超重组和肥胖组,差异均有统计学意义(均P<0.017);肥胖组患者高血压病比例、收缩压、总胆固醇、低密度脂蛋白胆固醇、三酰甘油均高于超重组患者,而估算的肾小球滤过率水平、双联抗血小板治疗比例均低于超重组,差异均有统计学意义(均P<0.017)。平均随访时间为(571.5±130.8)d,失访237例(8.0%),完成随访2727例(92.0%)。体重正常组患者死亡23例(2.8%),超重组死亡23例(1.6%),肥胖组死亡8例(1.1%),三组间比较差异有统计学意义(P=0.027)。单因素分析显示,年龄、BMI、糖尿病、左心室射血分数、血红蛋白、估算的肾小球滤过率、空腹血糖、冠状动脉多支血管病变、PCI处理血管支数、完全血管血运重建是死亡的危险因素(均P<0.05)。将单因素分析P<0.2的变量纳入Cox回归多因素分析显示,与肥胖组患者比较,体重正常组患者术后死亡风险增高(HR 2.241,95%CI 1.154～4.350,P=0.017),超重组患者术后死亡风险差异无统计学意义(HR 1.908,95%CI 0.689～5.291,P=0.213)。结论在接受择期PCI的患者中,超重和肥胖患者预后好于体重正常患者。

Objective To investigate the influence of body mass index（BMI） on the prognosis of patients who had received elective PCI. Methods The study population consisted of 2964 consecutive patients with elective PCIs performed between July 2009 and September 2011. The patients were divided into three groups based on their preoperative BMI levels：the normal group（ BMI 24.0 kg/m^2,n=810）; the overweight group（ 24.0 kg/m^2≤ BMI28.0 kg/m^2,n=1454） and the obese group（BMI ≥ 28.0 kg/m^2,n=700）. We examined the association between baseline BMI levels and postoperative mortality through a mean（571.5±130.8）days of follow up. Results Patients with high BMI had a higher percentage of comorbidities compared with the normal BMI group. The results of multivariate Cox regression analysis revealed that preoperative BMI was inversely associated with mortality after adjustment for other factors（HR 0.896,95% CI 0.821–0.977,P=0.031）. Compared with the obese group, the hazard ratios for risk of mortality in the overweight and the normal groups were 1.908（95% CI 0.689–5.291,P=0.213） and 2.241（95% CI 1.154–4.350,P=0.017）. Conclusions For patients undergoing elective PCI, individuals with obesity and overweight had the better prognosis than those with normal BMI.