摘要
目的:分析在合并2型糖尿病的慢性心力衰竭(心衰)患者中体质指数(BMI)对预后的影响及肥胖矛盾的存在情况。方法:回顾性分析2014-2015年我院收治的226例合并2型糖尿病的心衰住院患者,根据BMI分为3组:体重正常组(18.5kg/m^2≤BMI<24kg/m^2)、超重组(24kg/m^2≤BMI<28kg/m^2)、肥胖组(BMI≥28kg/m^2),于2016-06-07对患者进行随访。比较各组临床指标、全因死亡及主要不良心血管事件(MACE,包括心源性死亡及心衰再住院)情况。结果:226例患者均完成随访,体重正常组92例,超重组93例,肥胖组41例。发生全因死亡28例(12.4%),发生MACE 101例(44.7%)。其中,体重正常组和肥胖组全因死亡率分别为14.1%(13/92)和12.2%(5/41),均高于超重组的10.8%(10/93)。体重正常组和肥胖组MACE发生率分别为50%(46/92)和58.5%(24/41),均高于超重组的33.3%(32/93),差异有统计学意义(P<0.05)。应用KaplanMeier曲线,超重组MACE均低于其他2组(P<0.01),但全因死亡率方面无显著差异(P>0.05)。Cox比例风险回归模型中,与肥胖组患者相比,在调整了其他因素后,体重正常组的MACE[风险比(RR)=0.605,95%可信区间(CI):0.363~1.008,P=0.054]风险降低,超重组MACE(RR=0.430,95%CI:0.251~0.738,P<0.01)风险降低更为明显。结论:肥胖矛盾可能不存在于合并2型糖尿病的心衰人群中,将BMI控制在28kg/m^2以下可能有益于减少不良心血管事件的发生。
Objective：To evaluate the effect of body mass index（BMI）on the prognosis of patients with chronic heart failure（CHF）and type 2diabetes（T2DM）,and to explore the existence of the obesity paradox.Method：A total of 226 patients with CHF and T2 DM in our hospital from 2014 to 2015were included in this retrospective study.Patients were divided into 3groups according to their BMI：normal weight group（18.5kg/m2≤BMI〈24.0kg/m2）,overweight group（24kg/m2≤BMI〈28kg/m2）and obese group（BMI≥28kg/m2）.Followed-up was completed from June to July,2016.We analyzed the clinical parameters,the all-cause mortality and the major adverse cardiovascular events（MACE）,including cardiac death and rehospitalization for heart failure from these groups.Result：A total of 226 patients were finished during follow up（92in normal weight group,93 in overweight group and 41 in obesity group）.There were 28 cases of（12.4%）all-cause deaths and 101cases（44.7%）of MACE.Incidence of all-cause mortality in the normal weight group 14.1%（13/92）and in the obese group12.2%（5/41）,was both higher than that in the overweight group 10.8%（10/93）（P=0.784）.Similarly,the incidence of MACE in the normal weight group 50%（46/92）and in the obese group 58.5%（24/41）,was also both higher than that in the overweight group 33.3%（32/93）（P〈0.05）.Kaplan-Meier curves showed the incidence of MACE were lower in the overweight group than that in the other two groups（P〈0.01）.There was no difference in the all-cause mortality among three groups（P=0.824）.Multivariate Cox regression model showed normal weight patients had decreased risk for MACE（RR=0.605,95%CI：0.363~1.008,P=0.054）compared with patients of obesity group.Overweight patients had more obvious decreased risk for MACE（RR=0.430,95%CI：weight patients had decreased risk for MACE（RR=0.605,95%CI：0.363~1.008,P=0.054）compared with patients of obesity group.Overweight patients had more obvious decreased risk for MACE（RR=0.430,95%CI：0.251~0.738,P〈0.01）.Conclusion：The obesity paradox may absence in patients with CHF and T2 DM.BMI control under 28kg/m^2 may help reduce the incidence of MACE.
作者
汪贵清
陈小瑞
肖松林
高洁
唐博
王淋
陈运清
WANG Guiqing CHEN Xiaorui XIAO Songlin GAO Jie TANG Bo WANG Lin CHEN Yunqing(Department of Cardiology, the Second Hosipital of Chongqing Medical University, Chongqing, 400010, China 299th Japanese Clinical Classes, China Medical University)
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2017年第2期157-161,共5页
Journal of Clinical Cardiology
关键词
肥胖矛盾
体质指数
2型糖尿病
心力衰竭
obesity paradox
body mass index
type 2 diabetes
heart failure
