Survival advantages of excess body mass index in patients with idiopathic pulmonary arterial hypertension
Survival advantages of excess body mass index in patients with idiopathic pulmonary arterial hypertension
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DOI：
10.1080/ac.69.6.1000010
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发表时间：
2014-12-01
影响因子：
1.6
通讯作者：
Xiong, Chang-Ming
中科院分区：
文献类型：
--
作者：
Hu, En-Ci;He, Jian-Guo;Xiong, Chang-Ming
目的在心力衰竭患者中发现肥胖悖论，即随着体重指数(BMI)的增加，发病率和死亡率的“矛盾”下降。然而，BMI对特发性肺动脉高压(IPAH)患者的影响尚未被研究。本研究旨在探讨体重指数(BMI)是否是影响IPAH预后的因素。按体重指数分为体重不足(18.5 kg/m(2))、正常体重(18.5~24.9 kg/m(2))、超重(25~34.9 kg/m(2))。3组BMI患者右心导管血流动力学参数和NT-proBNR水平相似，超重和肥胖组年龄较高，WHO功能分级较低，左心室舒张末内径(LVEDDS)较大。卡普兰-迈耶生存曲线显示，超重和肥胖组的存活率显著高于正常体重组和低体重组(分别为对数等级检验，P=0.027，P=0.000)。逐步回归分析显示，低BMI、高WHO功能分级、低心脏指数、较小的LVEDDS和缺乏靶向药物仍是IPAH死亡的独立预测因素。结论体重超标是IPAH患者死亡的保护性因素。
Objective An obesity paradox, a "paradoxical" decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure. However, the impact of BMI in patients with idiopathic pulmonary arterial hypertension (IPAH) has not been studied. This study aims to find out whether BMI is a prognostic factor in IPAH.Methods and results We analysed 173 patients with IPAH. The patients were subclassified into categories of BMI defined as underweight(< 18.5 kg/m(2)), normal weight (18.5 to 24.9 kg/m(2)), overweight and obese (25 to 34.9 kg/m(2)). The three BMI groups had similar profiles in terms of haemodynamic parameters assessed by right heart catheterization and level of NT-proBNR The overweight and obese group had higher age, and lower WHO functional class, larger left ventricular end-diastolic dimensions (LVEDDs) than the other two groups. The Kaplan-Meier survival curves for the three BMI categories demonstrated that the overweight and obese group had a significantly higher survival rate than the normal weight and underweight groups (log rank test, P = 0.027, P = 0.000, respectively). In a stepwise forward regression, lower BMI, higher WHO functional class, lower cardiac index, smaller LVEDDs and absence of targeted medication remained independent predictors of mortality.Conclusions Excess body mass is a protective factor for death in patients with IPAH.