Effect of body mass index on prognosis in patients with heart failure and type 2 diabetes
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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(18.5 kg/m2≤BMI＜24 kg/m2)、超重组(24 kg/m2≤BMI＜28 kg/m2)、肥胖组(BMI≥28 kg/m2),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Kaplan-Meier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28 kg/m2以下可能有益于减少不良心血管事件的发生。Abstract: Objective:To evaluate the effect of body mass index(BMI) on the prognosis of patients with chronic heart failure(CHF) and type 2 diabetes(T2DM), and to explore the existence of the obesity paradox. Method:A total of 226 patients with CHF and T2DM in our hospital from 2014 to 2015 were included in this retrospective study. Patients were divided into 3 groups according to their BMI:normal weight group (18.5 kg/m2≤BMI＜24.0 kg/m2),overweight group (24 kg/m2≤BMI＜28 kg/m2) and obese group (BMI≥28 kg/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 (92 in normal weight group,93 in overweight group and 41 in obesity group).There were 28 cases of (12.4%) all-cause deaths and 101 cases (44.7%) of MACE.Incidence of all-cause mortality in the normal weight group 14.1％(13/92)and in the obese group 12.2%(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 T2DM. BMI control under 28 kg/m2 may help reduce the incidence of MACE.
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Key words:
- obesity paradox /
- body mass index /
- type 2 diabetes /
- heart failure
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