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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(P<0.05),纽约心功能分级和血清脑钠肽水平(BNP)低于低体重组(P<0.05)。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(P<0.05),左室舒张末期内径较低体重组明显缩小(P<0.05)。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(P<0.05)。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。
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: A total of 130 patients with HF undergoing CRT and follow-up were enrolled. Baseline BMI was divided into 3 groups according to the baseline of patients under CRT implantation: low body weight group (<18.5kg / m2, 21 cases), normal body weight group (18.5-23.9kg / m2, 75 cases) m2, 34 cases). Baseline clinical characteristics of each group and 6 months after cardiac ultrasound index changes. The Kaplan-Meier curves were used to analyze the major adverse cardiac events (MACE) including death, heart transplant or heart failure in different BMI groups. Cox multivariate regression analysis was used to analyze the independent predictive value of BMI for MACE. Results: At baseline, the proportion of diabetic patients with hemoglobin, albumin and hemoglobin in the overweight group were significantly higher than those in the low body weight group (P <0.05). The NYHA functional class and serum BNP level were lower than those in the low body weight group (P <0.05) . The level of left ventricular ejection fraction increased more significantly in the overweight group at 6 months after CRT than in the low weight group (P <0.05), and decreased significantly at the end diastolic diameter (P <0.05). The median follow-up time was 21 months. The incidence of MACE was significantly lower in the low-weight group than in the high-weight group (P <0.05). Cox multivariate risk models showed that BMI was an independent predictor of MACE (HR: 0.87, 95% CI: 0.79 to 0.97, P = 0.015). CONCLUSIONS: Patients with overweight and heart failure benefit more from CRT and low BMI is an independent predictor of poor clinical outcome after CRT.