体重指数对ST段抬高心肌梗死患者临床表现及其治疗和结局的影响

李玉泽; 孙宇姣; 张波; 姜大明; 高远; 于海杰; 齐国先

Abstract

李玉泽,孙宇姣,张波,姜大明,高远,于海杰,齐国先.体重指数对ST段抬高心肌梗死患者临床表现及其治疗和结局的影响[J].Chinese journal of Epidemiology,2012,33(12):1288-1292

体重指数对ST段抬高心肌梗死患者临床表现及其治疗和结局的影响

The impact of body mass index on the presentation, treatment and clinical outcomes of patients with ST-segment elevated myocardial infarction

Received:June 28, 2012 Revised:June 28, 2012

DOI：10.3760/cma.j.issn.0254-6450.2012.12.021

KeyWord: ST段抬高心肌梗死肥胖心脑血管事件

English Key Word: ST-segment elevation myocardial infarction Obesity Major adverse cardiovascular events

FundProject:辽宁省科学技术计划项目(200822500)

Author Name	Affiliation	E-mail
LI Yu-ze	Department of Cardiology, The First Affiliated Hospital of China Medical University.Shenyaag l10001, China
SUN Yu-jiao	Department of Cardiology, The First Affiliated Hospital of China Medical University.Shenyaag l10001, China
ZHANG Bo	Department of Cardiology.First Affiliated Hospital of Dalian Medical University
JIANG Da-ming	Department of Cardiology.Central Hospital of Dandong Cardiology
GAO Yuan	Department of Cardiology, The First Affiliated Hospital of China Medical University.Shenyaag l10001, China
YU Hai-jie	Department of Cardiology, The First Affiliated Hospital of China Medical University.Shenyaag l10001, China
QI Guo-xian	Department of Cardiology, The First Affiliated Hospital of China Medical University.Shenyaag l10001, China	qigx2002@medmail.com.cn

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Abstract:

目的评估体重指数(BMI)对ST段抬高心肌梗死(STEMI)患者的临床表现、治疗情况及临床结局的影响.方法连续选取2009年5月至2010年5月辽宁地区20家医院1414名STEMI患者,根据中国成年人BMI标准将患者分为正常体重组(18.5 kg/m2≤BMI＜24.0 kg/m2)485例、超重组(24.0 kg/m2≤BMI＜ 28.0 kg/m2) 736例和肥胖组(BMI≥28.0 kg/m2)193例,比较三组患者住院期间治疗及病死率、随访3个月和1年时治疗情况及主要心脑血管事件(MACCE)的发生.结果STEMI在肥胖组中更多为男性(P＜0.001),且年龄偏低(P＜0.001),以及较高的糖尿病(P＝0.013)、高血压(P＜0.001)和血脂异常(P＜0.001)患病率；住院期间肥胖组更多接受再灌注治疗(P＝0.018),主要方式是经皮冠状动脉介入治疗(PCI) (P＜0.001)；其他药物治疗以及病死率三组患者间的差异无统计学意义.随访3个月以及1年,肥胖组更多服用阿司匹林(3个月:P＝0.018;1年:P＝0.002)和β受体阻滞剂(3个月:P＝0.025;1年:P＝0.030),而MACCE发生率和累积生存率与体重正常组的差异无统计学意义.预测1年MACCE的危险因素为年龄(HR＝1.045,95%CI:1.028～1.062,P＜0.001)、糖尿病(HR＝ 1.530,95%CI:1.107～2.3 01,P＝0.041)、血脂异常(HR＝2.127,95%CI:1.317 ～ 3.435,P＝0.002)；保护因素为紧急PCI(HR＝0.473,95%CI:0.307～ 0.728,P＝0.001)、随访3个月时β受体阻滞剂的使用(HR＝0.373,95%CI:0.195～ 0.713,P＝0.003).结论 STEMI肥胖组患者可伴有更多的心血管病危险因素,虽获得更积极治疗,但其3个月及1年时MACCE的发生率与体重正常组和超重组相当,并无明确获益.

English Abstract:

Objective To analyze the impact of body mass index (BMI) on the presentation,treatment,and clinical outcomes of patients with ST-segment elevated myocardial infarction (STEMI).Methods 1414 patients with STEMI who were admitted to the 20 hospitals in Liaoning region from May 2009 until May 2010 were enrolled.Patients were stratified according to the BMI levels as normal weight group (18.5 kg/m2≤BMI＜24.0 kg/m2) (n＝485),overweight (24.0 kg/m2≤BMI＜28.0 kg/m2) (n＝736),or obesity (BMI≥28.0 kg/m2) (n＝193).Presentation,treatment and mortality during hospitalization,MACCE (cardiovascular death,non-fatal myocardial infarction,revascularization and stroke) were compared between the three groups at 3-month and 1-year follow-up.Results Obesity in patients with STEMI was associated with younger age (P＜0.001),being male (P＜0.001),with diabetes (P＝0.013) or hypertension (P＜0.001) and hyperlipidmia (P＜0.001).A higher prevalence of reperfusion treatment (P ＝ 0.018),mainly percutaneous coronary intervention (PCI) (P＜0.001) was seen during the period of hospitalization.Rates of using other kinds of medicines as well as the mortalities during hospitalization,were similar among the groups with different BMI categories.At 3-month and 1-year follow-up,more use of asprin (3-months:P＝0.018; 1-year:P＝0.002) and β-receptor blockers were seen in the obesity group (3-months:P＝0.025; 1-year:P＝0.030) while the use of other drugs were not significantly different among the three groups.The incidence rates of MACCE were not significantly different among the BMI categories while the cumulative survival rate was similar between obese group and normal weight group.Results from the Cox proportional hazards analysis indicated that factors as age (HR＝1.045,95% CI:1.028-1.062,P＜0.001),diabetes (HR＝ 1.530,95% CI:1.107-2.301,P＝0.041),hyperlipidmia (HR＝2.127,95% CI:1.317-3.435,P＝0.002),urgent PCI (HR＝0.473,95%CI:0.307-0.728,P＝0.001) and the use of β-receptor blockers at 3-months follow-up period (HR＝0.373,95% CI:0.195-0.713,P＝0.003) were significantly related to the incidence of MACCE at 1-year follow-up period.Conclusion Despite the fact that patients with obesity presented with STEMI at younger age and having received active treatment of reperfusion and medicine,both the 3-month and 1-year outcomes did not show significant difference among the BMI categories.

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