体质指数对心脏再同步化治疗患者远期预后的影响

发布时间：2018-08-06 10:54

【摘要】：目的:探讨基线体质指数(BMI)对接受心脏再同步化治疗(CRT)的慢性心力衰竭(心衰)患者远期预后的影响。方法:入选接受CRT治疗和随访的心衰患者共130例。根据患者植入CRT时基线BMI分为3组:低体重组(18.5kg/m2,21例)、正常体重组(18.5~23.9kg/m2,75例)、超重组(24.0~28.0kg/m2,34例)。比较各组基线临床特征及术后6个月心脏超声指标变化。采用Kaplan-Meier曲线分析不同BMI组间主要心脏不良事件率(MACE,包括死亡、心脏移植或心衰再入院),Cox多因素回归分析BMI对于MACE的独立预测作用。结果:基线时超重组糖尿病比例、血红蛋白水平、白蛋白水平显著高于低体重组(P0.05),纽约心功能分级和血清脑钠肽水平(BNP)低于低体重组(P0.05)。CRT术后6个月超重组较低体重组左室射血分数提高程度更明显(P0.05),左室舒张末期内径较低体重组明显缩小(P0.05)。中位随访时间为21个月,在MACE事件发生率方面低体重组显著高于超重组(P0.05)。Cox多因素风险模型显示,BMI是MACE的独立预测因子(HR:0.87,95%CI:0.79~0.97,P=0.015)。结论:超重心衰患者接受CRT后能够更多获益,低BMI是CRT术后不良临床预后的独立预测因素。
[Abstract]:Objective: to investigate the effect of baseline body mass index (BMI) on the long-term prognosis of patients with chronic heart failure (CHF) receiving cardiac resynchronization therapy (CRT). Methods: 130 patients with heart failure who were treated with CRT and followed up were enrolled. According to the baseline BMI at the time of CRT implantation, the patients were divided into three groups: low weight group (18.5 kg / m2), normal weight group (18.5% 23.9 kg / m2), and superrecombination (24.0 ~ 28.0 kg / m ~ (2) n = 34). The baseline clinical features and the changes of echocardiographic parameters at 6 months after operation were compared in each group. The Kaplan-Meier curve was used to analyze the independent predictive effect of BMI on MACE among different BMI groups (including death, heart transplantation or readmission to heart failure). Results: the ratio of superrecombinant diabetes mellitus and the level of hemoglobin at baseline, Albumin level was significantly higher than that in low body weight group (P0.05). New York cardiac function grade and serum brain natriuretic peptide (BNP) level were lower than those in low weight group (P0.05). The left ventricular ejection fraction (LVEF) was significantly increased at 6 months after CRT (P0.05), left ventricular end-diastolic fraction (LVED) was significantly higher than that in low weight group (P0.05). The inner diameter was significantly smaller than that in the low body weight group (P0.05). The median follow-up time was 21 months. The incidence of MACE events in low weight group was significantly higher than that in hyperrecombination (P0.05). Cox multivariate risk model showed that MACE was an independent predictor of MACE (HR: 0.8795 CI: 0.790.797P0. 015). Conclusion: patients with overweight heart failure can benefit more after CRT. Low BMI is an independent predictor of poor clinical prognosis after CRT.
【作者单位】：南京大学医学院附属鼓楼医院;
【基金】：南京市卫生局重点课题(No:ZKX13023) 江苏省卫计委指导性课题(No:Z201514) 江苏省卫生厅科研基金(No:Z201514)
【分类号】：R541.6

【相似文献】