体质量指数对慢性心力衰竭患者预后的影响  

Influence of body mass index on prognosis of patients with chronic heart failure

作　　者：吴穷 李慧[2] 任妍[3] 张凤如[3] 

机构地区：[1]上海罗店镇社区卫生服务中心全科,上海201908 [2]上海交通大学医学院附属瑞金医院卢湾分院心内科,上海200020 [3]上海交通大学医学院附属瑞金医院老年科,上海200025

出　　处：《内科理论与实践》2016年第3期176-179,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的：探讨体质量指数（BMI）与慢性心力衰竭（心衰）患者预后之间的关系。方法：选取慢性心衰患者603例,根据BMI分为低体重组（〈18.5）、正常组（18.5-24.9）、超重组（含偏胖）（25.0-29.9）、肥胖组（≥30.0）进行随访,观察各组间临床资料、生化指标、全因死亡及主要心血管事件（MCE）发生率的差异性。运用Kaplan-Meier曲线比较各组间生存率。采用多元COX回归评估BMI对心衰预后的影响。结果：低体重组患者女性比例最高、心率更快、脑钠肽前体（pro-BNP）水平更高（均P〈0.01）,心房颤动（房颤）患病率及MCE发生率明显增加（均P〈0.01）,血红蛋白、三酰甘油明显降低（均P〈0.01）,并且最少服用血管紧张素转化酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）、肾上腺素β受体拮抗剂等药物（均P〈0.05）。与肥胖组相比,低体重组死亡风险显著提高[相对危险度（RR）=8.658,P〈0.01],在校正了性别、年龄及慢性心衰的危险因素后,COX回归显示BMI降低是心衰死亡的独立危险因素（RR=0.404,95%可信区间：0.294-0.554,P〈0.01）。结论：慢性心衰患者中存在“肥胖悖论”,低BMI增加慢性心衰患者死亡率。Objectives To investigate the correlation between body mass index （BMI） and prognosis in patients with chronic heart failure （CHF）. Methods A total of 603 patients with chronic heart failure were categorized according to BMI into underweight group （〈18.5）, normal group （18.5-24.9）, overweight group（25-29.9） and obese group （1〉30）. The differ- ences in clinical features, biochemical indexes, overall death rate and major cardiovascular events （MCE） between these groups were analyzed. The survival rates of these groups were compared by Kaplan-Meier curve. The effect of BMI on prognosis of heart failure was assessed by multivariate COX regression analysis. Results Underweight group had the high- est percentage of female, faster heart rate, higher pro-brain natriuretic peptide （BNP） level, higher prevalence of atrial fib- rillation and major cardiovascular events （all P〈0.01）. Hemoglobin and triglyceridelevel were significantly decreased in un- derweight group（all P〈0.01）. Underweight group received angiotensin converting enzyme inhibitor （ACEI）/angiotensin II re- ceptor antagonist（ARB）, 13-adrenoreceptor antagonist less frequently（all P〈0.05）. Mortality was significantly increased with decrease of BMI in patients with heart failure. Compared with obese group, the risk of death was significantly increased in underweight group [relative risk （RR）=8.658, P〈0.01]. After adjustment for gender, age and other chronic heart failure risk factors, COX regression analysis showed that BMI reduction was an independent risk factor for mortality of heart failure （RR=0.404, 95% confidence interval： 0.294-0.554, P〈0.01）. Conclusions There is a ＂obesity paradox＂ in patients with chronic heart failure. Actually, low BMI increases the mortality in patients with heart failure.

关 键 词：心力衰竭 体质量指数 预后 

分 类 号：R541.6[医药卫生—心血管疾病]