Body Composition and Mortality in Coronary Artery Disease With Mild Renal Insufficiency in Chinese Patients
Body Composition and Mortality in Coronary Artery Disease With Mild Renal Insufficiency in Chinese Patients
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中国冠心病伴轻度肾功能不全患者的身体成分和死亡率
DOI：
10.1053/j.jrn.2017.01.018
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发表时间：
2017-05-01
影响因子：
3.2
通讯作者：
Huang, De-jia
中科院分区：
文献类型：
--
作者：
Peng, Yong;Chen, Fei;Huang, De-jia
目的：肥胖是冠状动脉疾病（CAD）和慢性肾功能不全（RI）的危险因素; CAD患者易于发生肥胖和RI。在这项研究中，我们试图分析身体成分对轻度RI的CAD患者死亡的影响。设计：回顾性队列研究。受试者：总共有1，591名连续的CAD患者被纳入，这些患者经冠状动脉造影证实，并通过估计肾小球滤过率达到轻度RI标准：60-90 mL/min。主要结果测量：在不同的身体成分中，包括身体质量指数（BMI）、身体脂肪（BF）和瘦体重指数（LMI），检测身体成分对CAD死亡率的影响。终点为全因死亡率。结果：生存曲线显示，低BMI组的死亡风险高于高BMI组（总体P = .002的对数秩）; LMI与死亡风险呈负相关，因此，较低的LMI与较高的死亡风险相关（总体P < .001的对数秩）。BF和死亡风险之间没有显著相关性。多因素校正显示LMI与死亡风险仍呈负相关（五分位数1：参考;五分位数2：风险比[HR]：0.49，95%置信区间[CI]：0.26-0.92;五分位数3：HR：0.35，95% CI：0.17-0.70;五分位数4：HR：0.41，95% CI：0.20-0.85;五分位数5：人力资源部：结论：对于轻度RI的冠心病患者，BMI、BF与死亡风险无关，而LMI与死亡风险呈负相关。在这项研究中观察到一个弱的“肥胖悖论”。(C)2017年由国家肾脏基金会，Inc. All rights reserved.
Objective: Obesity is a risk factor for both coronary artery disease (CAD) and chronic renal insufficiency (RI); patients with CAD are prone to obesity and RI. In this study, we try to analyze the effect of body composition on death in CAD patients with mild RI.Design: Retrospective cohort study.Subjects: A total of 1,591 consecutive CAD patients confirmed by coronary angiography were enrolled and met the mild RI criteria by estimated glomerular filtration rate: 60-90 mL/min.Main Outcome Measurements: The influence of body composition on mortality of CAD was detected in different body compositions, including body mass index (BMI), body fat (BF), and lean mass index (LMI). The end points were all-cause mortality. Cox models were used to evaluate the relationship of quintiles of body compositions with all-cause mortality.Results: A survival curve showed that the risk of death was higher in the low BMI group than in the high BMI group (log-rank for overall P = .002); LMI was inversely correlated with risk of death, such that a lower LMI was associated with a higher risk of death (log-rank for overall P < .001). No significant correlation was observed between BF and risk of death. Multifactorial correction show that LMI was still inversely correlated with risk of death (quintile 1: reference; quintile 2: hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.26-0.92; quintile 3: HR: 0.35, 95% CI: 0.17-0.70; quintile 4: HR: 0.41, 95% CI: 0.20-0.85; quintile 5: HR: 0.28, 95% CI: 0.12-0.67).Conclusion: For CAD patients with mild RI, BMI or BF was unrelated to risk of death, while LMI was inversely correlated with risk of death. A weak "obesity paradox'' was observed in this study. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.