研究结果发现，在慢性收缩性心力衰竭（HF）中观察到的所谓”肥胖悖论”同样适用于急性失代偿性HF，尽管两者潜在的病理生理机制存在着差别。该研究结果发表在《美国心脏杂志》。
Gregg Fonarow（美国加利福尼亚大学洛杉矶医学中心）和他的同事在分析急性失代偿心衰国家注册研究（ADHERE）的数据时发现，体重指数（BMI）与住院病人死亡率呈负相关。根据标准体重分类，ADHRE中的超重和肥胖患者的相对死亡风险分别较正常体重患者低26.1％和47.8％。而那些体重过轻的患者其死亡风险较正常体重者高37.0％。
Fonarow研究小组对ADHERE 中来自263个中心的108，927名患者进行了研究，所有患者均为2001年10月至2004年12月入院时有有身高和体重记录的住院患者。将患者按BMI四分位值分为四组，最低（Q1）到最高（Q4）四分位组的BMI分别是16.0-23.6 kg/m2，23.7-27.7 kg/m2，27.8-33.3 kg/m2和 33.4-60.0 kg/m2。
研究结果显示，与BMI下四分位值的患者相比， BMI处于上四分位值的患者更年轻，合并有糖尿病、高血压和高脂血症的人更多（两组之间的所有差异p<0.0001）。相反，BMI位于上四分位值的患者很少有HF、心房颤动或冠心病史。随着BMI四分位值的增加，患者住院死亡率近似线性下降，在分别考虑到下降和保留的左室射血分数后，这种关系仍然存在。此外，在调整了年龄、性别、血尿素氮、血压、肌酐、血钠、心率和静息呼吸困难之后，BMI仍旧能预测死亡风险，该模型的受试者操作特性曲线下面积为0.76。
作者总结道，“在这项急性失代偿性HF患者的大规模研究中，BMI越高的患者其住院期间死亡率越低，这种相关性独立于其他与预后有关的变量。”今后还需进行深入研究以更好的了解HF、肥胖和临床结果之间的关系。对HF住院患者进行急性营养和代谢干预可能有益。
Obesity paradox extends to acute decompensated heart failure
29 December 2006
Study findings suggest that the so-called obesity paradox observed in chronic systolic heart failure (HF) also applies in acute decompensated HF, despite the two conditions having distinct underlying pathophysiologic mechanisms.
Gregg Fonarow (University of California-Los Angeles Medical Center, USA) and colleagues found that body mass index (BMI) was inversely associated with in-hospital mortality in their analysis of data from the Acute Decompensated HF National Registry (ADHERE).
According to standard weight categories, patients in ADHERE classed as overweight and obese had relative mortality risks 26.1% and 47.8% lower, respectively, than those of people with normal body mass. Conversely, those who were underweight had a 37.0% higher mortality risk than normal weight individuals.
Fonarow and team studied 108,927 ADHERE patients hospitalized at 263 centers between October 2001 and December 2004 who had their height and admission weight recorded.
Patients were divided into BMI quartiles, with ranges 16.0-23.6 kg/m2, 23.7-27.7 kg/m2, 27.8-33.3 kg/m2, and 33.4-60.0 kg/m2 from the lowest (Q1) to the highest (Q4).
Patients in higher BMI quartiles were significantly younger than those in lower quartiles, and were significantly more likely to have a history of diabetes, hypertension, and hyperlipidemia, than those in the lower quartiles (p<0.0001 for all between-group differences).
In contrast, individuals in higher BMI quartiles were significantly less likely to have a history of HF, atrial fibrillation, or coronary artery disease, than those in the lower quartiles, the authors note in the American Heart Journal.
In-hospital mortality rates decreased in a near-linear fashion across increasing BMI quartiles, a relationship which held true when patients with reduced and preserved left ventricular ejection fraction were considered separately.
Furthermore, BMI still predicted mortality risk in the overall cohort after adjustment for age, gender, blood urea nitrogen, blood pressure, creatinine, sodium, heart rate, and dyspnea at rest, with an area under the receiver operating characteristic curve for the model of 0.76.
"In this large cohort of hospitalized patients with acute decompensated HF, higher BMI was associated with a significantly lower in-hospital mortality risk independent of other prognostic variables," the authors conclude.
They add that further studies are needed to better understand the relationship between HF, adiposity, and clinical outcomes, and that acute nutritional and metabolic interventions may help patients hospitalized with HF.
Am Heart J 2006; 153: 74-81
http://www.incirculation.net/NewsItem/Obesity-paradox-extends-to-acute-decompensated-hea.aspx
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