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摘要: 目的 探讨BMI与慢性心力衰竭(心衰)预后的关系。方法 回顾性收集2015年5月—2020年6月在首都医科大学附属北京友谊医院住院的315例慢性心衰患者的临床资料，并进行2年随访。根据BMI将患者分为低体重组(BMI≤18.5 kg/m2)14例、正常体重组(18.5 kg/m2＜BMI＜25 kg/m2)137例、超重组(25 kg/m2≤BMI＜30 kg/m2)115例、肥胖组(30 kg/m2≤BMI＜35 kg/m2)34例和严重肥胖组(BMI≥35 kg/m2)15例，分析各组基线资料差异，应用logistic回归分析心衰患者全因死亡、心源性死亡与BMI的关系。结果 2年随访结果显示，低体重、正常体重、超重、肥胖和严重肥胖组慢性心衰患者全因死亡率分别为50%、32.1%、13%、5.9%和6.7%，其中超重及肥胖组的全因死亡率显著低于正常体重组(P＜0.001)，但严重肥胖组的全因死亡率高于肥胖组；5组心源性死亡率分别为35.7%、27.7%、10.4%、5.9%和0，随着BMI增加，心源性死亡率呈逐渐下降趋势(P＜0.001)。经多因素校正后，logistic回归分析结果显示，超重和肥胖是慢性心衰患者预后的独立相关因素。结论 BMI可用于评估心衰患者预后，低BMI是慢性心衰患者2年预后的独立危险因素。BMI在一定范围内符合“肥胖悖论”，但严重肥胖可导致心衰患者全因死亡率上升。Abstract: Objective To investigate the relationship between BMI and prognosis of chronic heart failure.Methods We retrospectively analyzed clinical data of 315 patients hospitalized with chronic heart failure in Beijing Friendship Hospital Affiliated with Capital Medical University from May 2015 to June 2020, patients were followed up for 2 years. According to BMI, patients were divided into the under-weight group(BMI≤18.5 kg/m2, n=14), normal-weight group(18.5 kg/m2 < BMI < 25 kg/m2, n=137), over-weight group(25 kg/m2≤BMI < 30 kg/m2, n=115), obese group(30 kg/m2≤BMI < 35 kg/m2, n=34), and severe-obese group(BMI≥35 kg/m2, n=15). Baseline data were compared among the five groups. Logistic regression was used to analyze the relationship between all-cause mortality, cardiac death, and BMI.Results The 2-year follow-up results showed that the all-cause mortality rates in the under-weight weight, normal-weight, over-weight, obese, and severe-obese groups were 50%, 32.1%, 13%, 5.9%, and 6.7%, respectively, and the rate in the over-weight and obese groups was significantly lower than that in the normal-weight group(P < 0.001), but in the severe-obese group was higher than that in the obese group. The cardiac mortality rates in the 5 groups were 35.7%, 27.7%, 10.4%, 5.9%, and 0, respectively, the rate gradually decreased as BMI increased(P < 0.001). After multiple factor adjustment, the results of logistic regression analysis showed that over-weight and obese were independent prognostic factors for patients with chronic heart failure.Conclusion BMI can be used to assess the prognosis of patients with heart failure, and the lower BMI is an independent risk factor for the 2-year prognosis of patients with chronic heart failure. BMI conforms to the obesity paradox in a certain range, but severe obese can lead to an increase in all-cause mortality in patients with heart failure.
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Key words:
- heart failure /
- BMI /
- risk factors /
- prognosis
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表 1 患者临床基线资料
Table 1. Clinical baseline data
例(%), M(P25, P75) 项目 低体重组(14例) 正常体重组(137例) 超重组(115例) 肥胖组(34例) 严重肥胖组(15例) P 年龄/岁 68(63，74) 75(65，81) 73(62，81) 69(58，78) 52(30，72) 0.001 男性 7(50) 78(56.9) 74(64.3) 15(44.1) 5(33.3) 0.074 既往心衰住院 5(35.7) 64(46.7) 48(41.7) 6(17.6) 9(60.0) 0.019 吸烟 5(35.7) 55(40.1) 53(46.1) 10(29.4) 5(33.3) 0.451 高血压 5(35.7) 90(65.7) 92(80.0) 28(82.4) 12(80.0) 0.002 糖尿病 2(14.3) 48(35.0) 38(33.0) 13(38.2) 6(40.0) 0.552 心脏瓣膜病 4(28.6) 21(15.3) 16(13.9) 2(5.9) 2(13.3) 0.338 冠心病史 4(28.6) 78(56.9) 61(53.0) 12(35.3) 7(46.7) 0.078 肾功能不全史 2(14.3) 35(25.5) 39(33.9) 5(14.7) 4(26.7) 0.167 脑血管 2(14.3) 26(19.0) 20(17.4) 5(14.7) 3(20.0) 0.977 收缩压/mmHg 120(110，133) 126(110，140) 129(119，146) 130(121，143) 135(120，163) 0.023 舒张压/mmHg 72(64，77) 70(63，80) 74(68，84) 80(70，90) 90(80，110) ＜0.001 药物应用 抗凝药 3(21.4) 23(16.8) 32(27.8) 8(23.5) 4(26.7) 0.292 ACEI/ARB 10(71.4) 94(68.6) 83(72.2) 26(76.5) 12(80.0) 0.860 β受体阻滞剂 12(85.7) 116(84.7) 95(82.6) 32(94.1) 14(93.3) 0.513 袢利尿剂 13(92.9) 126(92.0) 106(92.2) 32(94.1) 15(100.0) 0.959 螺内酯 11(78.6) 113(82.5) 83(72.2) 33(97.1) 15(100.0) 0.002 1 mmHg=0.133 kPa。抗凝药：华法林、达比加群、利伐沙班；ACEI/ARB：血管紧张素转化酶抑制剂/血管紧张素受体阻断剂；袢利尿剂：呋塞米、托拉塞米。 
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表 2 各组实验室检查指标
Table 2. Laboratory test indexes
M(P25, P75) 项目 低体重组(14例) 正常体重组(137例) 超重组(115例) 肥胖组(34例) 严重肥胖组(15例) P HGB/(g/L) 116(101，132) 121(97，137) 128(108，141) 135(120，144) 127(115，138) 0.030 LDL-C/(mmol/L) 1.9(1.5，2.4) 1.8(1.4，2.4) 1.9(1.5，2.3) 1.9(1.4，2.5) 2.2(1.8，3.1) 0.121 BUN/(mmol/L) 8.5(6.7，11.1) 7.4(5.3，10.9) 7.8(5.8，11.6) 5.8(5.1，8.3) 5.1(4.7，7.9) ＜0.001 Cr/(μmol/L) 89(70，113) 96(75，126) 92(72，140) 81(60，103) 87(73，102) 0.107 NT-proBNP/(ng/L) 12 028 (2 776，19 362) 4 740 (2 034，11 445) 4 127 (1 983，8 910) 3 330 (1 220，7 309) 3 911 (1 701，6 190) 0.171 HbA1c/% 5.5(5.1，6.0) 6.1(5.7，7.0) 6.1(5.6，6.7) 6.0(5.6，6.9) 6.1(5.2，7.3) 0.084 LVEF/% 40(24，59) 45(36，60) 50(36，63) 56(37，61) 42(33，55) 0.467 HGB：血红蛋白；BUN：尿素氮。
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表 3 各组2年随访期间心血管事件发生情况
Table 3. Cardiovascular events during the 2-year follow-up period in each group
例(%) 项目 低体重组(14例) 正常体重组(137例) 超重组(115例) 肥胖组(34例) 严重肥胖组(15例) P 心衰再入院 5(35.7) 54(39.4) 31(27.0) 11(32.4) 5(33.3) 0.341 全因死亡 7(50.0) 44(32.1) 15(13.0) 2(5.9) 1(6.7) ＜0.001 心源性死亡 5(35.7) 38(27.7) 12(10.4) 2(5.9) 0 ＜0.001 非心源性死亡 2(14.3) 3(2.2) 1(0.9) 0 1(6.7) 0.038
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表 4 2年全因死亡的危险因素分析
Table 4. Risk factors for 2-year all-cause mortality
变量 单因素 多因素 OR(95%CI) P OR(95%CI) P 体重 正常体重 参考 参考 低体重 2.114(0.69~6.39) 0.185 5.441(1.45~20.28) 0.012 超重 0.317(0.16~0.60) 0.001 0.230(0.10~0.49) ＜0.001 肥胖 0.132(0.03~0.57) 0.007 0.181(0.03~0.85) 0.031 严重肥胖 0.151(0.01~1.18) 0.072 0.404(0.04~3.80) 0.429 年龄 1.059(1.02~1.08) ＜0.001 1.061(1.02~1.09) 0.001 男性 1.699(0.97~2.97) 0.063 3.170(1.54~6.51) 0.002 既往心衰入院 1.838(1.07~3.14) 0.027 2.085(1.08~4.02) 0.028 高血压 1.690(0.88~3.22) 0.112 4.382(1.84~10.42) 0.001 ACEI/ARB 0.582(0.33~1.02) 0.060 0.822(0.41~1.61) 0.569 β受体阻滞剂 0.364(0.18~0.70) 0.003 0.421(0.18~0.93) 0.034 醛固酮受体拮抗剂 0.904(0.46~1.76) 0.766 NT-proBNP 1.000(1.00~1.00) 0.002 1.000(1.00~1.00) 0.016
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表 5 2年心源性死亡的危险因素分析
Table 5. Risk factors for 2-year cardiac death mortality
变量 单因素 多因素 OR(95%CI) P OR(95%CI) P 体重 正常体重 参考 参考 低体重 1.447(0.45~4.59) 0.531 2.523(0.66~9.63) 0.176 超重 0.304(0.15~0.61) 0.001 0.269(0.12~0.58) 0.001 肥胖 0.163(0.03~0.71) 0.016 0.230(0.05~1.06) 0.060 年龄 1.050(1.02~1.08) 0.001 1.040(1.00~1.07) 0.027 男性 1.511(0.83~2.74) 0.175 既往心衰入院 1.853(1.04~3.30) 0.036 1.832(0.94~3.55) 0.073 高血压 2.037(0.97~4.23) 0.057 3.747(1.54~9.07) 0.003 ACEI/ARB 0.626(0.34~1.14) 0.129 0.804(0.40~1.61) 0.537 β受体阻滞剂 0.435(0.21~0.88) 0.021 0.459(0.20~1.03) 0.061 醛固酮受体拮抗剂 0.857(0.42~1.74) 0.670 NT-proBNP 1.000(1.00~1.00) 0.001 1.000(1.00~1.00) 0.018
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[1] 王华, 刘宇佳, 杨杰孚. 心力衰竭流行病学[J]. 临床心血管病杂志, 2023, 39(4): 243-247. doi: 10.13201/j.issn.1001-1439.2023.04.001
[2] 国家心血管病医疗质量控制中心专家委员会心力衰竭专家工作组. 2020中国心力衰竭医疗质量控制报告[J]. 中国循环杂志, 2021, 36(3): 221-238. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202103002.htm
[3] Simati S, Kokkinos A, Dalamaga M, et al. Obesity Paradox: Fact or Fiction?[J]. Curr Obes Rep, 2023, 12(2): 75-85. doi: 10.1007/s13679-023-00497-1
[4] Zhang J, Begley A, Jackson R, et al. Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis[J]. Clin Res Cardiol, 2019, 108(2): 119-132. doi: 10.1007/s00392-018-1302-7
[5] Fröhlich H, Frey N, Frankenstein L, et al. The Obesity Paradox in Heart Failure: Is It Still Valid in Light of New Therapies?[J]. Cardiology, 2022, 147(5-6): 529-538. doi: 10.1159/000527332
[6] 王华, 梁延春. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYW201910003.htm
[7] Lai KY, Wu TH, Liu CS, et al. Body mass index and albumin levels are prognostic factors for long-term survival in elders with limited performance status[J]. Aging(Albany NY), 2020, 12(2): 1104-1113.
[8] Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association[J]. Circulation, 2021, 143(21): e984-e1010.
[9] Dramé M, Godaert L. The Obesity Paradox and Mortality in Older Adults: A Systematic Review[J]. Nutrients, 2023, 15(7): 1780. doi: 10.3390/nu15071780
[10] Horwich TB, Fonarow GC, Clark AL. Obesity and the Obesity Paradox in Heart Failure[J]. Prog Cardiovasc Dis, 2018, 61(2): 151-156. doi: 10.1016/j.pcad.2018.05.005
[11] Carbone S, Lavie CJ, Elagizi A, et al. The Impact of Obesity in Heart Failure[J]. Cardiol Clin, 2022, 40(2): 209-218. doi: 10.1016/j.ccl.2021.12.009
[12] Mandviwala TM, Basra SS, Khalid U, et al. Obesity and the paradox of mortality and heart failure hospitalization in heart failure with preserved ejection fraction[J]. Int J Obes(Lond), 2020, 44(7): 1561-1567. doi: 10.1038/s41366-020-0563-1
[13] Yoshihisa A, Sato T, Kajimoto K, et al. Heterogeneous impact of body mass index on in-hospital mortality in acute heart failure syndromes: An analysis from the ATTEND Registry[J]. Eur Heart J Acute Cardiovasc Care, 2019, 8(7): 589-598. doi: 10.1177/2048872617703061
[14] Marcks N, Aimo A, Januzzi JL Jr, et al. Re-appraisal of the obesity paradox in heart failure: a meta-analysis of individual data[J]. Clin Res Cardiol, 2021, 110(8): 1280-1291. doi: 10.1007/s00392-021-01822-1
[15] Huang L, Zhao X, Liang L, et al. Obesity Paradox in Heart Failure Revisited: Etiology as Effect Modifier[J]. Am J Cardiol, 2023, 207: 294-301. doi: 10.1016/j.amjcard.2023.09.024
[16] Schwann TA, Ramia PS, Engoren MC, et al. Evidence and temporality of the obesity paradox in coronary bypass surgery: an analysis of cause-specific mortality[J]. Eur J Cardiothorac Surg, 2018, 54(5): 896-903. doi: 10.1093/ejcts/ezy207
[17] Song S, Tien CL, Cui H, et al. Myocardial Rev-erb-Mediated Diurnal Metabolic Rhythm and Obesity Paradox[J]. Circulation, 2022, 145(6): 448-464.
[18] Mehta A, Meng Q, Li X, et al. Vascular Regenerative Capacity and the Obesity Paradox in Coronary Artery Disease[J]. Arterioscler Thromb Vasc Biol, 2021, 41(6): 2097-2108. doi: 10.1161/ATVBAHA.120.315703
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