肥胖程度对急性ST段抬高型心肌梗死患者预后的影响

doi:10.3969/j.issn.1006-7795.2022.02.005

摘要/Abstract

摘要： 目的探讨肥胖程度对于急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者预后的影响。方法连续入选2013-2018年因首次发作STEMI收入首都医科大学宣武医院治疗的患者,按照体质量指数(body mass index, BMI)(kg/m²)将患者分为4组:低体质量组(A组):BMI<18.5 kg/m²;正常体质量组(B组):18.5 kg/m²≤BMI<24 kg/m²;超重组(C组):24.0 kg/m²≤BMI<28.0 kg/m²;肥胖组(D组):BMI≥28.0 kg/m²。比较4组患者住院和随访期间的全因死亡和主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE)发生率。结果低体质量组和其他3组相比男性患者所占比例更高,年龄更大。患者住院接受再灌注治疗的比例随BMI的增加整体呈现上升趋势。住院期间低体质量、正常体质量、超重和肥胖组的住院全因病死率分别为14.71%、3.97%、2.89%和3.09%,差异有统计学意义(P=0.003),低体质量组的全因病死率显著高于超重组和肥胖组。Kaplan-Meier生存曲线显示,低体质量、正常体质量、超重和肥胖组患者的5年预期全因病死率分别为37.0%、19.5%、13.8%、13.0%,差异有统计学意义(P=0.040),低体质量组的5年预期全因病死率显著高于其他3组。用限制性立方样条(restricted cubic spline,RCS)拟合Cox回归模型显示,BMI与随访全因死亡和发生MACCE的风险之间均呈U型关系。在用Cox回归分析校正了混杂因素后,BMI不是STEMI患者远期死亡或MACCE的独立预测因素。结论肥胖程度对STEMI患者的远期预后没有直接影响。

关键词: 肥胖, 体质量指数, 急性ST段抬高型心肌梗死, 预后

Abstract: Objective To investigate the effect of obesity level on the prognosis of patients with ST-segment elevation myocardial infarction(STEMI). Methods One thousand five hundreds and fifty-three patients admitted to our hospital from October 2013 to December 2018 were categorized into group A[underweight, body mass index (BMI)<18.5 kg/m²], group B(normal weight, 18.5 kg/m²≤BMI <24 kg/m²), group C(overweight,24.0 kg/m²≤BMI<28.0 kg/m²), and group D(obesity, BMI≥28.0 kg/m²) according to their body mass index (BMI)(kg/m²). Mortality and rates of major adverse cardiovascular and cerebrovascular events (MACCE) were compared between the four groups at hospital and 6-year follow-up. Results Underweight group has more male patients compared with the other three groups, and is older than the other three groups. The overall trend of the rate of revascularization during hospital is rising as BMI increases. The mortality rates of underweight group, normal weight group, overweight group and obesity group during hospitalization were 14.71%, 3.97%, 2.89% and 3.09% (P=0.003), respectively. The mortality of underweight group was significantly higher than the mortality of overweight group and obesity group. The expected five-year all-cause mortality rates shown in the Kaplan-Meier survival curves for patients in underweight group, normal weight group, overweight group and obesity group were 37.0%, 19.5%, 13.8%, and 13.0% (P=0.040), respectively. The expected five-year all-cause mortality is significantly higher in underweight group than in the other three groups. The Cox regression model fitted with restricted cubic spline (RCS) shows that there is a U-shaped relationship between BMI and follow-up death and the risk of MACCE. After correcting the mixed factors with Cox regression model, BMI is not an independent predictor of long-term death or MACCE in STEMI patients. Conclusion The level of obesity had no direct effect on the long-term prognosis of STEMI patients.

Key words: obesity, body mass index, acute ST-segment elevation myocardial infarction, prognosis

中图分类号:

R541.4

苗祖霈, 张迎花, 肖克令, 司瑾, 张浩宇, 李静. 肥胖程度对急性ST段抬高型心肌梗死患者预后的影响[J]. 首都医科大学学报, 2022, 43(2): 192-198.

Miao Zupei, Zhang Yinghua, Xiao Keling, Si Jin, Zhang Haoyu, Li Jing. Influence of obesity on the prognosis of patients with STEMI[J]. Journal of Capital Medical University, 2022, 43(2): 192-198.

参考文献

[1] 《中国心血管健康与疾病报告2020》编写组. 《中国心血管健康与疾病报告2020》概述[J]. 中国心血管病研究, 2021, 19(7): 582-590.
[2] 佚名. 中国居民营养与慢性病状况报告(2020年)[J]. 营养学报, 2020, 42(6): 521.
[3] Powell-Wiley T M, Poirier P, Burke L E, et al. Obesity and cardiovascular disease: a scientific statement from the American heart association[J]. Circulation, 2021, 143(21): e984-e1010.
[4] Elagizi A, Kachur S, Carbone S, et al. A review of obesity, physical activity, and cardiovascular disease[J]. Curr Obes Rep, 2020, 9(4): 571-581.
[5] Lavie C J, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases and Prognosis-The obesity paradox updated[J]. Prog Cardiovasc Dis, 2016, 58(5): 537-547.
[6] Qasim A, Turcotte M, De Souza R J, et al. On the origin of obesity: identifying the biological, environmental and cultural drivers of genetic risk among human populations[J]. Obes Rev, 2018, 19(2): 121-149.
[7] Carbone S, Canada J M, Billingsley H E, et al. Obesity paradox in cardiovascular disease: where do we stand?[J]. Vasc Health Risk Manag, 2019, 15: 89-100.
[8] Moscarella E, Spitaleri G, Brugaletta S, et al. Impact of body mass index on 5-year clinical outcomes in patients with ST-segment elevation myocardial infarction after everolimus-eluting or bare-metal stent implantation[J]. Am J Cardiol, 2017, 120(9): 1460-1466.
[9] 王欢欢, 赵雪燕, 高展, 等. 体重指数对行介入治疗的急性ST段抬高型心肌梗死患者长期预后的影响[J]. 中国循环杂志, 2017, 32(4): 348-352.
[10] Shahim B, Redfors B, Chen S, et al. BMI, infarct size, and clinical outcomes following primary PCI: patient-level analysis from 6 randomized trials[J]. JACC Cardiovasc Interv, 2020, 13(8): 965-972.
[11] Neeland I J, Das S R, Simon D N, et al. The obesity paradox, extreme obesity, and long-term outcomes in older adults with ST-segment elevation myocardial infarction: results from the NCDR[J]. Eur Heart J Qual Care Clin Outcomes, 2017, 3(3): 183-191.
[12] 田承亮, 郗汇聪. 肥胖冠心病患者PCI术前后血清NLR、HMGB1、NT-proBNP水平及其远期预后的影响因素分析[J]. 国际检验医学杂志, 2021, 42(13): 1622-1625.
[13] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志, 2019, 47(10): 766-783.
[14] Champagne-Langabeer T, Kim J, Bower J K, et al. Obesity, treatment times, and cardiovascular outcomes after ST-elevation myocardial infarction: findings from mission: lifeline North Texas[J]. J Am Heart Assoc, 2017, 6(9): e005827.
[15] Joyce E, Hoogslag G E, Kamperidis V, et al. Relationship between myocardial function, body mass index, and outcome after ST-segment-elevation myocardial infarction[J]. Circ Cardiovasc Imaging, 2017, 10(7): e005670.
[16] Endo H, Dohi T, Shitara J, et al. Impact of body mass index on long-term outcomes in Japanese patients following percutaneous coronary intervention: the juntendo PCI registry[J]. J Cardiol, 2018, 72(3): 208-214.
[17] Chatterjee K, Gupta T, Goyal A, et al. Association of obesity with in-hospital mortality of cardiogenic shock complicating acute myocardial infarction[J]. Am J Cardiol, 2017, 119(10): 1548-1554.
[18] Sattar N, Welsh P. The obesity paradox in secondary prevention: a weighty intervention or a wait for more evidence?[J]. Eur Heart J, 2020, 41(28): 2678-2680.