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目的:分析在合并2型糖尿病的慢性心力衰竭(心衰)患者中体质指数(BMI)对预后的影响及肥胖矛盾的存在情况。方法:回顾性分析2014-2015年我院收治的226例合并2型糖尿病的心衰住院患者,根据BMI分为3组:体重正常组(18.5kg/m~2≤BMI<24kg/m~2)、超重组(24kg/m~2≤BMI<28kg/m~2)、肥胖组(BMI≥28kg/m~2),于2016-06-07对患者进行随访。比较各组临床指标、全因死亡及主要不良心血管事件(MACE,包括心源性死亡及心衰再住院)情况。结果:226例患者均完成随访,体重正常组92例,超重组93例,肥胖组41例。发生全因死亡28例(12.4%),发生MACE 101例(44.7%)。其中,体重正常组和肥胖组全因死亡率分别为14.1%(13/92)和12.2%(5/41),均高于超重组的10.8%(10/93)。体重正常组和肥胖组MACE发生率分别为50%(46/92)和58.5%(24/41),均高于超重组的33.3%(32/93),差异有统计学意义(P<0.05)。应用KaplanMeier曲线,超重组MACE均低于其他2组(P<0.01),但全因死亡率方面无显著差异(P>0.05)。Cox比例风险回归模型中,与肥胖组患者相比,在调整了其他因素后,体重正常组的MACE[风险比(RR)=0.605,95%可信区间(CI):0.363~1.008,P=0.054]风险降低,超重组MACE(RR=0.430,95%CI:0.251~0.738,P<0.01)风险降低更为明显。结论:肥胖矛盾可能不存在于合并2型糖尿病的心衰人群中,将BMI控制在28kg/m~2以下可能有益于减少不良心血管事件的发生。
OBJECTIVE: To analyze the effect of body mass index (BMI) on the prognosis and the prevalence of obesity in patients with chronic heart failure (CHF) with type 2 diabetes mellitus. Methods: A retrospective analysis of 226 hospitalized CHF patients with type 2 diabetes admitted to our hospital from 2014 to 2015 was divided into 3 groups according to BMI: normal weight group (18.5kg / m ~ 2≤BMI <24kg / m ~ 2 ), Overweight group (24kg / m ~ 2≤BMI <28kg / m ~ 2) and obesity group (BMI≥28kg / m ~ 2) The clinical indicators, all-cause mortality and major adverse cardiovascular events (MACE, including cardiac death and heart failure) were compared. Results: All 226 patients were followed up. There were 92 cases of normal weight group, 93 cases of overweight group and 41 cases of obesity group. All-cause death occurred in 28 patients (12.4%) and MACE occurred in 101 patients (44.7%). Among them, all-cause mortality in normal weight group and obesity group were 14.1% (13/92) and 12.2% (5/41), respectively, which were all higher than 10.8% (10/93) in overweight group. The incidence of MACE in normal weight group and obesity group were 50% (46/92) and 58.5% (24/41) respectively, which were significantly higher than those in overweight group (33.3%, 32/93) ). Using KaplanMeier curve, MACE in overweight group was lower than the other two groups (P <0.01), but there was no significant difference in all cause mortality (P> 0.05). In the Cox proportional hazards regression model, MACE [hazard ratio (RR) = 0.605, 95% confidence interval (CI): 0.363 to 1.008, P = 0.054] risk reduction, overweight MACE (RR = 0.430, 95% CI: 0.251 ~ 0.738, P <0.01), the risk reduction more pronounced. Conclusion: Obesity may not exist in people with heart failure complicated by type 2 diabetes. Controlling BMI below 28kg / m2 may be beneficial in reducing the incidence of adverse cardiovascular events.