摘要
目的探讨体质指数(BMI)与慢性心力衰竭(HF)患者新发心房颤动风险的关系。方法本研究为回顾性队列研究,纳入张家口市第一医院于2020至2023年间诊断为慢性HF的患者512例,根据BMI分为低体重(n=45)正常体重(n=212)超重(n=203)和肥胖(n=52)四组。主要结局为新发心房颤动。随访3年。采用Kaplan-Meier生存分析、多因素Cox回归分析、限制性立方样条(RCS)分析和亚组分析评估BMI与新发心房颤动风险的关系。结果KaplanMeier分析显示,低体重、超重和肥胖组新发心房颤动风险显著高于正常体重组(Log-rankP=0.020)。多因素Cox回归分析表明,与正常体重组相比,超重组(HR=1.56,95%CI:1.05~2.32,P=0.019)和肥胖组(HR=2.38,95%CI:1.38~4.10,P=0.002)新发心房颤动风险显著增加。RCS分析显示BMI与新发心房颤动风险呈U型非线性关系(非线性P<0.001)。亚组分析发现,BMI与新发心房颤动的关联在女性中更强(P交互=0.046),且仅在舒张压≤90mmHg(HR=1.19,95%CI:1.13~1.25,P<0.001)和脑钠肽(BNP)≤300pg/mL(HR=1.15,95%CI:1.08~1.22,P<0.001)亚组中显著。结论慢性心力衰竭患者BMI与新发心房颤动风险呈U型关系,超重和肥胖患者新发心房颤动风险显著增加。这种关联在女性、舒张压较低和BNP水平较低的患者中更为显著。
Objective To investigate the relationship between body mass index(BMI)and the risk of new-onset atrial fibrillation(NOAF)in patients with chronic heart failure(CHF).Methods This study was a retrospective cohort study.A total of 512 patients diagnosed with CHF were included at Zhangjiakou First Hospital between 2020 and 2023,and they were divided into 4 groups based on body mass index(BMI):underweight group(n=45),normal weight group(n=212),overweight group(n=203),and obese group(n=52).The primary outcome was NOAF.The follow-up duration was 3 y.Kaplan-Meier survival analysis,multivariate Cox regression analysis,restricted cubic spline(RCS)analysis,and subgroup analysis were used to evaluate the relationship between BMI and NOAF risk.Results Kaplan-Meier analysis showed that NOAF risk was significantly higher in underweight,overweight,and obese groups than that in normal weight group(Log-rank P=0.020).Multivariate Cox regression analysis indicated that compared with normal weight group,NOAF risk was significantly increased in overweight group(HR=1.56,95%CI:1.05~2.32,P=0.019)and obese group(HR=2.38,95%CI:1.38~4.10,P=0.002).RCS analysis revealed a U-shaped non-linear relationship between BMI and NOAF risk(non-linear P<0.001).Subgroup analysis found that the association between BMI and NOAF was stronger in females(P for interaction=0.046),and was only significant in subgroups with diastolic blood pressure(DBP)<90 mmHg(HR=1.19,95%CI:1.13~1.25,P<0.001)and B-type natriuretic peptide(BNP)≤300 pg/mL(HR=1.15,95%CI:1.08~1.22,P<0.001).Conclusion There is a U-shaped relationship between BMI and NOAF risk in CHF patients,and overweight and obese patients have a significantly increased risk.This association is more pronounced in female patients and those with lower DBP and BNP level.
作者
马雁宏
王蕊
梁津津
MA Yanhong;WANG Rui;LIANG Jinjin(Department of Cardiac Surgery,Zhangjiakou First Hospital,Zhangjiakou,Hebei 075000,China;Department of Cardiovascular Medicine,First Hospital,HeBei North University,Zhangjiakou,Hebei 075000,China;Department of Cardiac Surgery,First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China)
出处
《中国循证心血管医学杂志》
2025年第11期1364-1368,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河北省张家口市重点研发计划项目(2322092D)。
关键词
体质指数
慢性心力衰竭
新发心房颤动
性别差异
body mass index
chronic heart failure
new-onset atrial fibrillation
gender differences
