体重指数与急性冠脉综合征患者院内不良心脑血管事件的相关性  

The association between body mass index and in-hospital major adverse cardiovascular and cerebral events in patients with acute coronary syndrome

作　　者：周晴 朱丹[2] 王怡亭 董文阅 杨杰 温军 刘军[3] 杨娜 赵冬[3] 花欣炜 唐熠达 Qing Zhou;Dan Zhu;Yiting Wang;Wenyue Dong;Jie Yang;Jun Wen;Jun Liu;Na Yang;Dong Zhao;Xinwei Hua;Yida Tang(Department of Cardiology,Fuwai Hospital and Cardiovascular Institute,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,Research Unit of Medical Science Research Management/Basic and Clinical Research of Metabolic Cardiovascular Diseases,Chinese Academy of Medical Sciences,State Key Laboratory of Vascular Homeostasis and Remodeling,National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191,China;Center of Clinical and Epidemiology Researches,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院冠心病中心,北京100037 [2]北京大学第三医院心内科、中国医学科学院医学科研管理/代谢性心血管疾病基础与临床研究创新单元、血管医学研究所、血管稳态与重构全国重点实验室、国家卫生健康委心血管分子生物学与调节肽重点实验室、心血管受体研究北京市重点实验室,北京100191 [3]首都医科大学附属北京安贞医院、北京市心肺血管疾病研究所临床与流行病研究中心,北京100029

出　　处：《中华心血管病杂志》2024年第1期42-48,共7页Chinese Journal of Cardiology

基　　金：中国医学科学院医学与健康科技创新工程项目(2021-I2M-5-003);心血管代谢疾病的前瞻性队列(Y73541-49);北京大学医学青年科技创新培育基金(BMU2022PY026)。

摘　　要：目的了解体重指数(BMI)与急性冠脉综合征(ACS)患者院内主要不良心脑血管事件(MACCE)的相关性。方法该研究是一项多中心前瞻性队列研究。研究数据来源于中国心血管疾病医疗质量改善(CCC)项目。入选2014年11月1日至2019年12月31日CCC项目中年龄介于18~80岁的ACS住院患者,按照入院第1次测得的BMI分为4组:低体重组(BMI<18.5 kg/m^(2))、正常体重组(BMI 18.5~24.9 kg/m^(2))、超重组(BMI 25.0~29.9 kg/m^(2))和肥胖组(BMI≥30.0 kg/m^(2))。主要结局为住院期间发生的MACCE,包括全因死亡、再次心肌梗死、心力衰竭、心原性休克、心脏骤停和卒中。采用多因素logistic回归模型分析BMI与院内MACCE发生风险的关系。结果研究共纳入71681例ACS住院患者,年龄(63.4±14.7)岁,女性占26.5%(18979/71681),低体重组、正常体重组、超重组和肥胖组分别有2154、41960、24140和3427例。低体重组、正常体重组、超重组和肥胖组的院内MACCE发生率分别为14.9%(322/2154)、9.5%(3997/41960)、7.9%(1908/24140)和7.0%(240/3427)(P<0.001)。多因素logistic回归分析结果显示,低体重组的MACCE发生风险高于正常体重组(OR=1.30,95%CI 1.13~1.49,P<0.001),超重组和肥胖组MACCE发生风险与正常体重组差异均无统计学意义(P均>0.05)。结论BMI低于正常的ACS患者院内MACCE发生风险高,BMI有可能成为评价ACS患者短期预后的一项指标。Objective To assess the association between body mass index(BMI)and major adverse cardiovascular and cerebrovascular events(MACCE)among patients with acute coronary syndrome(ACS).Methods This was a multicenter prospective cohort study,which was based on the Improving Care for Cardiovascular Disease in China(CCC)project.The hospitalized patients with ACS aged between 18 and 80 years,registered in CCC project from November 1,2014 to December 31,2019 were included.The included patients were categorized into four groups based on their BMI at the time of admission:underweight(BMI<18.5 kg/m^(2)),normal weight(BMI between 18.5 and 24.9 kg/m^(2)),overweight(BMI between 25.0 and 29.9 kg/m^(2)),and obese(BMI≥30.0 kg/m^(2)).Multivariate logistic regression models was used to analyze the relationship between BMI and the risk of in-hospital MACCE.Results A total of 71681 ACS inpatients were included in the study.The age was(63.4±14.7)years,and 26.5%(18979/71681)were female.And the incidence of MACCE for the underweight,normal weight,overweight,and obese groups were 14.9%(322/2154),9.5%(3997/41960),7.9%(1908/24140)and 7.0%(240/3427),respectively(P<0.001).Multivariate logistic regression analysis showed a higher incidence of MACCE in the underweight group compared to the normal weight group(OR=1.30,95%CI 1.13-1.49,P<0.001),while the overweight and obese groups exhibited no statistically significant difference in the incidence of MACCE compared to the normal weight group(both P>0.05).Conclusion ACS patients with BMI below normal have a higher risk of in-hospital MACCE,suggesting that BMI may be an indicator for evaluating short-term prognosis in ACS patients.

关 键 词：急性冠状动脉综合征 体重指数 预后 

分 类 号：R541.4[医药卫生—心血管疾病]