体重指数对慢性心力衰竭患者全因死亡风险的预测作用

摘要

目的:研究体重指数(BMI)在预测慢性心力衰竭(心衰)患者全因死亡风险中的作用.方法:对入选的1 197例慢性心衰患者进行随访,以全因死亡为随访终点.将人群按BMI的四分位数分为BMI≤21.6 kg/m2组(低BMI组,n=288)、21.6 kg/m226.7 kg/m2组(高BMI组,n=304)四组.先比较不同BMI水平各项临床指标的差异,再应用Kaplan-Meier曲线及Log-rank检验对不同BMI人群的生存率进行描述及比较,多因素Cox回归用于分析BMI降低对心衰预后的独立预测作用及不同BMI人群的死亡风险比较.结果:完成随访1 025例(失访率14.4%),死亡360例(35.1%);随访中位数44个月.不同BMI水平的心衰患者在合并症、血压、左心室射血分数、检验项目及用药方面存在显著差异.随着BMI降低,心衰患者死亡风险增加.校正其他影响因素后,BMI降低(风险比1.089,P<0.001)为心衰死亡的独立预测因素;与高BMI组相比,中BMI组、正常BMI组及低BMI组的死亡风险逐渐升高(风险比分别为1.619、1.647及2.111),差异均有统计学意义(P均<0.05).结论:年龄、BMI、左心室射血分数、合并短阵/持续性室性心动过速、是否应用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂和袢利尿剂、血红蛋白、总胆红素、尿酸、甘油三酯均为心衰死亡的独立预测因素,低BMI增加心衰的死亡率.%Objective:To explore the predictive value of body mass index( BMI )for all cause mortality in patients with chronic heart failure( CHF ).rnMethods:A cohort of 1197 consecutive CHF patients were summarized. They were divided into four groups by quartiles of BMI. Low group,BMI≤21. 6kg/m2 ,n = 288 ,Normal group,21. 6 kg/m226. 7kg/m2 ,n = 304. The relationship between BMI leves and certain clinical features was analyzed. Kaplan-Meier curve and Log-rank test were used to describe the patients condition. Multivariate Cox regression model was performed to reveal the independent predictive values of BMI for all cause mortality among different groups.rnResults:There were 1025/1197 patients finished the median follow-up time of 44 months, 14. 4% patients lost contact and 360( 35.1% )died. There were significant differences in complication, blood pressure, left ventricular ejection fraction( LVEF ), laboratory test and medication among different groups. The risk of mortality elevated accordingly with reduced BMI levels. With adjusted risk factors,decreased BMI remained as an independent predictor of mortality with hazard ratio of 1. 089,P<0. 001 in CHF patients. Compared with High group,the hazard ratios for risk of mortality in Medium,Normal and Low groups were 1. 619, 1. 647 and 2.111 respectively,all P<0. 05.rnConclusion: Age,BMI,LVEF,history of ventricular tachycardia,using of angiotensin converting enzyme inhibitor/angiotensin receptor blocker and loop-diuretics; hemoglobin, total bilirubin,uric acid and triglyceride were all independent predictors for mortality, and lower BMI increasing the risk of mortality in CHF patients.