不同体质指数慢性心力衰竭患者预后的差异性研究

Disparities of Prognosis in Chronic Heart Failure Patients with Different BMI

背景慢性心力衰竭患者存在"肥胖矛盾"现象,这与临床所提倡的"先减重以降低心脏负担"有悖,而目前关于不同体质指数(BMI)慢性心力衰竭患者预后的差异性研究报道较少。目的比较不同BMI慢性心力衰竭患者预后的差异。方法选取新疆医科大学第一附属医院2017年1月-2018年1月收治的慢性心力衰竭患者125例,根据BMI分为正常/过低体质量组(BMI为17.0~24.9 kg/m^2)68例、超重组43例(BMI为25.0~29.9 kg/m^2)及肥胖组14例(BMI为30.0~45.0 kg/m^2);另根据随访期间主要不良心血管事件(MACE)发生情况分为MACE组30例和无MACE组95例。比较正常/过低体质量组、超重组及肥胖组患者性别、年龄、左心室射血分数(LVEF)、纽约心脏病协会(NYHA)分级、病程、吸烟及饮酒情况、合并症、治疗药物及MACE发生情况,并绘制Kaplan-Meier生存曲线以评价三组患者MACE发生情况;比较MACE组和无MACE组患者临床特征及BMI,慢性心力衰竭患者随访期间MACE的影响因素分析采用多元Cox比例风险回归分析。结果 (1)正常/过低体质量组、超重组及肥胖组患者性别、年龄、LVEF、NYHA分级、病程、吸烟率、饮酒率、糖尿病发生率、慢性阻塞性肺疾病(COPD)发生率、脑卒中发生率、冠心病发生率、风湿性心脏病发生率、心肌病发生率、高血压发生率、β-受体阻滞剂治疗率、血管紧张素转换酶抑制剂(ACEI)治疗率、利尿剂治疗率、强心剂治疗率比较,差异无统计学意义(P>0.05);超重组、肥胖组患者随访期间MACE发生率低于正常/过低体质量组(P<0.05)。Kaplan-Meier生存曲线显示,肥胖组、超重组患者随访期间累积MACE发生率低于正常/过低体质量组(P<0.05)。(2)MACE组和无MACE组患者性别、年龄、LVEF、NYHA分级、病程、吸烟率、饮酒率、糖尿病发生率、COPD发生率、脑卒中发生率、冠心病发生率、风湿性心脏病发生率、心肌病发生率、高血压发生率、β-受体阻滞剂治疗率、ACEI治疗率、利尿剂治疗率、强心剂治疗率比较,差异无统计学意义(P>0.05);MACE组患者BMI低于无MACE组(P<0.05)。多元Cox比例风险回归分析结果显示,BMI介于25.0~29.9 kg/m^2是慢性心力衰竭患者随访期间MACE的独立保护因素(P<0.05)。结论与超重患者相比,正常/过低体质量的慢性心力衰竭患者MACE发生风险较高、预后较差,临床医护人员应根据慢性心力衰竭患者BMI制定有针对性的个体营养方案。

Background There is obesity paradox in patients with chronic heart failure,which is contrary to the clinical suggestion of "Lose weight first to reduce the heart burden",however researches about disparities of prognosis in chronic heart failure patients with different BMI are relatively rare so far. Objective To compare the disparities of prognosis in chronic heart failure patients with different BMI. Methods A total of 125 patients with chronic heart failure were selected in the First Affiliated Hospital of Xinjiang Medical University from January 2017 to January 2018,and they were divided into normal/underweight group(with BMI between 17.0 and 24.9 kg/m^2,n=68),overweight group(with BMI between 25.0 and 29.9 kg/m^2,n=43) and obesity group(with BMI between 30.0 and 45.0 kg/m^2,n=14) according to the BMI;MACE group(n=30) and non-MACE group(n=95) according to incidence of MACE during followed-up. Gender,age,LVEF,NYHA grading,course of disease,smoking rate,drinking rate,incidence of combined disease,therapeutic and incidence of MACE during follow-up were compared in the normal/underweight group,overweight group and obesity group;Kaplan-Meier survival curve was drawn to evaluate the incidence of MACE in the three groups;clinical features and BMI were compared between the MACE group and non-MACE group,and multivariate Cox proportional hazard regression analysis was used to analyze the influencing factors of MACE in patients with chronic heart failure during followed-up. Results(1)There was no statistically significant difference in gender,age,LVEF,NYHA grading,course of disease,smoking rate,drinking rate,incidence of diabetes,COPD,stroke,coronary heart disease,rheumatic heart disease,cardiomyopathy or hypertension,utilization rate of β-blockers,ACEI,diuretic or cardiotonic in normal/underweight group,overweight group and obesity group(P>0.05);incidence of MACE during follow-up in obesity group and overweight group was statistically significantly lower than that in normal/underweight group(P< 0.05). Kaplan-Meier survival curve showed that,cumulative incidence of MACE in obesity group and overweight group was statistically significantly lower than that in normal/underweight group during followed-up(P<0.05).(2)There was no statistically significant difference in gender,age,LVEF,NYHA grading,course of disease,smoking rate,drinking rate,incidence of diabetes,COPD,stroke,coronary heart disease,rheumatic heart disease,cardiomyopathy or hypertension,utilization rate of β-blockers,ACEI,diuretic or cardiotonic between MACE group and non-MACE group(P>0.05);BMI in MACE group was statistically significantly lower than that in non-MACE group(P<0.05).Multivariate Cox proportional hazard regression analysis results showed that,BMI between 25.0 and 29.9 kg/m^2 was the independent protective factor of MACE in patients with chronic heart failure during followed-up(P<0.05). Conclusion Compared with that in chronic heart failure patients with overweight,the risk of MACE is relatively high and the prognosis is relatively poor in chronic heart failure patients with normal/underweight,thus clinical medical staff should make targeted individual nutrition program according to the BMI.