体重指数与急性胰腺炎患者严重程度及预后相关性的Meta分析

目的评价体重指数(BMI)与急性胰腺炎患者严重程度及预后相关性。方法通过计算机检索Pubmed、Embase、Cochrane-Library数据库中关于BMI与急性胰腺炎严重程度及预后胡相关性研究,根据标准筛选文献,进行质量评估和数据提取,采用Revman5.3软件进行Meta分析。结果共纳入19项研究,Meta分析结果显示,肥胖患者患重症胰腺炎风险及死亡率更高(OR=2.76,95%CI=1.39～5.48;OR=1.55,95%CI=1.16～2.06),全身、局部并发症发生率也高于非肥胖患者(OR=1.70,95%CI=1.08～2.67;OR=2.22,95%CI=1.69～2.93);与非超重患者相比,超重患者拥有更高的重症胰腺炎发生率、死亡率及并发症发生率(OR=2.81,95%CI=1.69～4.66;OR=2.93,95%CI=1.10～7.80;OR=3.06,95%CI=1.25～7.47;OR=2.59,95%CI=1.81～3.69);与正常体重患者比较,低体重的急性胰腺炎患者拥有更高的死亡率(OR=1.81,95%CI=1.31～2.51)。结论超重及肥胖均影响急性胰腺炎患者的严重程度及预后;同时,低体重的急性胰腺炎患者死亡风险增加。     

糖尿病前期合并肥胖症患者的饮食治疗

糖尿病前期又称糖尿病调节受损(IGR),这些人血糖已升至正常水平以上。他们在空腹血糖(IFG)和(或)糖耐量试验中,服糖后2h血糖(IGT)高于正常,但还没达到诊断糖尿病的标准[1]。这些患者无多饮、多尿及体重下降现象,且体重指数(BMI)>28kg/m2(BMI=18.5～23.9kg/m2为正常,BMI=24～27.9kg/m2为超重,BMI≥28kg/m2为肥胖[1])。本研究旨在探讨饮食治疗配合规律运动对患者的血糖和体重的影响。     

孕前肥胖和妊娠期糖尿病风险的临床研究

目的:探讨孕前肥胖是否增加妊娠期糖尿病风险及先兆子痫、巨大儿、妊娠期高血压的发病率。方法:观察240例孕妇,120例为肥胖组(BMI≥28 kg/m2),120例为正常组(BMI为18.5²3.9 kg/m2)。比较两组孕妇的临床特点、产科和新生儿结局,统计分析相对风险和95%可信区间(CI)。结果:与正常组孕妇比较,肥胖组孕妇妊娠期糖尿病风险不增加,RR=0.9[95%CI0.623.9 kg/m2)。比较两组孕妇的临床特点、产科和新生儿结局,统计分析相对风险和95%可信区间(CI)。结果:与正常组孕妇比较,肥胖组孕妇妊娠期糖尿病风险不增加,RR=0.9[95%CI0.6¹.4];先兆子痫、巨大儿及妊娠期高血压相对风险分别为RR=0.7[95%CI0.21.4];先兆子痫、巨大儿及妊娠期高血压相对风险分别为RR=0.7[95%CI0.2³.3],RR=1.4[95%CI 0.53.3],RR=1.4[95%CI 0.5⁴.3]及RR=12[95%CI 1.64.3]及RR=12[95%CI 1.6⁹0.8]。结论:无代谢异常的孕前肥胖并不增加妊娠期糖尿病、先兆子痫及巨大儿风险,但是增加妊娠期高血压的风险。     

经皮冠状动脉介入治疗早期与后期应用阿昔单抗疗效及安全性的meta分析

目的：系统评价经皮冠状动脉介入治疗（PCI）术前早期与后期应用阿昔单抗的疗效及安全性。方法：计算机检索PubMed、Springer、Ovid、Embase、Cochrance Library、Clinicaltrails.gov和CNKI、万方数据库,检索从建库开始至2013年5月的所有相关临床随机对照研究。同时检索纳入文献的参考文献,并逐个进行质量评价和资料提取。统计学分析采用RevMan5.0软件。结果：共纳入12个随机对照试验,共计2886例患者。Meta分析结果显示,PCI术前早期应用阿昔单抗并不能降低患者近期[OR=0.95,95%CI（0.78,1.17）]及远期[OR=0.71,95%CI（0.47,1.07）]的MACE发生率,亦不能降低患者近期[OR=1.02,95%CI（0.70,1.48）]及远期[OR=0.44,95%CI（0.18,1.06）]的死亡率。但患者术前[OR=2.29,95%CI（1.53,3.43）]及术后[OR=1.59,95%CI（1.10,2.31）]达心肌梗死溶栓治疗（TIMI）3级血流的比例明显增加;患者术后ST-段完全回落的比例也显著增加[OR=1.86,95%CI（1.33,2.59）]。且两组严重出血的发生率没有统计学差异[OR=1.33,95%CI（0.87,2.05）]。结论：现有的资料表明,PCI术前早期应用阿昔单抗虽不能降低患者MACE及死亡的发生率,但可以有效改善患者术前及术后的心肌灌注水平,改善患者心功能,且不增加严重出血的发生率。     

营养过剩性肥胖儿童血压与体重指数的相关分析

目的 分析营养过剩性肥胖儿童血压与体重指数的相关性.方法 对290名营养过剩性肥胖儿童的体重指数(BMI)进行随机抽样及整群分层,横断面调查各自的血压及BMI,并进行相关性分析及Logistic回归分析.结果 营养过剩性肥胖儿童的收缩压(SBP)和舒张压(DBP)与BMI均呈正相关,偏相关系数分别为0.2574和0.2319(P＜0.05),并且各自血压值与BMI值呈正相关(P＜0.05).儿童患高血压的相对危险度(RR)以及SBP与DBP超标率均与BMI值呈正相关.Logistic回归分析显示,BMI和年龄对SBP和DBP值有影响(P＜0.05).年龄因素修正后,体重高一级分类,患高血压的RR是低一级的2.09倍;其RR的95%CI为2.16～2.73.结论 营养过剩性肥胖儿童的SBP、DBP与BMI呈独立正相关.     

早期抗生素暴露与儿童肥胖风险的Meta分析

目的 系统评价早期抗生素暴露与儿童肥胖风险的相关性。方法 计算机检索PubMed、CNKI、维普期刊和万方等数据库，检索时限为从建库至2017年9月，由2位研究员独立筛选早期抗生素暴露与儿童肥胖风险的队列研究，提取资料并评价纳入研究的质量，采用Stata 12.0软件进行Meta分析。结果 纳入15个队列研究，共465648例研究对象。Meta分析结果显示：①早期抗生素暴露会增加儿童超重和肥胖的风险(超重：RR=1.20，95%CI 1.08~1.32；肥胖：RR=1.23，95%CI 1.19~1.27)；②以性别为亚组进行分析，男孩亚组和女孩亚组都有超重的风险(男：RR=1.35，95%CI 1.17~1.53；女：RR=1.17，95%CI 1.00~1.33)；③早期抗生素暴露会增加儿童BMI z值和体重z值(BMI z值：MD=0.06，95%CI 0.03~0.08；体重z值：MD=0.07，95%CI 0.02~0.11)。结论 早期抗生素暴露会增加儿童肥胖风险，儿童使用抗生素需谨慎。鉴于纳入文献的质量和样本来源问题，结论尚需进一步验证。     

孕前体重及孕期增重与妊娠结局的关系

目的 探讨孕妇孕前体重及孕期增重与妊娠结局的关系.方法 选取2010年1月至2010年12月在我院产前检查并住院分娩的单胎产妇600例.根据孕前体重指数(BMI)分为4组:低体重组BMI＜18.5,正常体重组18.5≤BMI＜24,超重组24≤BMI＜28,肥胖组BMI≥28,再根据孕期体重指数增长幅度分为3组:A组(BMI增加＜4)、B组(BMI增加4～6)、C组(BMI增加＞6).分析不同分组的剖宫产率、巨大儿发生率、妊高症、GDM发生率、产后出血、切口恢复情况.结果 肥胖组及孕期体重指数增加＞6者,剖宫产率、巨大儿发生率、妊娠合并症率、切口愈合不良发生率明显高于正常组.结论 作好围产期保健,注意控制孕前体重,监测并控制孕期体重增长幅度,减少肥胖,可明显改善妊娠结局.     

高危急性冠脉综合征病人经皮冠状动脉支架植入术术后发生氯吡格雷抵抗的相关因素及预后分析

目的 探讨高危急性冠脉综合征(ACS)病人经皮冠状动脉支架植入术 (PCI)术后对P2Y12受体拮抗剂抑制血小板聚集的反应性及影响因素,同时在此基础上探讨对病人预后的影响.方法 86例ACS行PCI术病人,分为氯吡格雷抵抗(CR)组24例,无氯吡格雷抵抗(NCR)组62例.运用焦磷酸测序技术,检测其CYP2C19*2,*3单核苷酸多态性及二磷酸腺苷(ADP)诱导的血小板聚集率,分析病人CR与基因型的关系.经Logistic回归分析CR的影响因素,并对病人进行1年的心脏不良事件(MACE)、卒中、呼吸困难、出血事件的随访.结果 单因素及Logistic回归分析表明,野生基因型(OR=0.15,P=0.011,95%CI=0.04~0.67)是CR的保护因素;而高血压病史(P=0.021,OR=8.136,95%CI=1.48~44.80)、空腹血糖值(P=0.012,OR=1.51,95%CI=1.10~2.06)、基础血小板聚集率(P=0.023,OR=1.06,95%CI=0.01~1.11)等3个因素是CR的危险影响因素;此外,术后1年随访,总MACE发生率CR组为29.2%,明显高于NCR的9.7%.结论 CYP2C19基因型与CR引发的心血管事件有重要关联.CYP2C19野生型基因是高危ACS病人发生CR的保护因素;高血压病史、高空腹血糖值、血小板高反应性为CR的危险因素,CR组病人PCI术后MACE事件显著增高.CYP2C19*2,*3是CR发生的独立预测因子,CR作为独立危险因素,预示着心血管事件发生的危险增加.     

移动医疗应用程序在肥胖多学科门诊体重管理中的作用

目的 观察在肥胖多学科门诊联合移动医疗应用程序(APP)辅助体重管理对超重或肥胖患者的减重效果。方法 80例超重或肥胖患者随机均分为两组，B组予以常规肥胖门诊体重管理，A组在此基础上联合移动医疗APP辅助体重管理。观察两组干预4、8和12周后体重相关指标、体成分、肥胖相关代谢指标、摄食量及行为方式变化情况。结果 74例患者完成随访(A组39例，B组35例)。A组干预12周后体重较干预前下降(9.2±3.9)%,高于B组的(6.0±5.0)%(P<0.01);A组减重≥5%患者比例高于B组(87.2%vs. 51.4%)(P<0.01)。A组干预12周后体重、BMI、体脂肪、体脂百分比、躯干脂肪、内脏脂肪面积、糖化血红蛋白、高密度脂蛋白胆固醇及蛋白质供能比等方面改善均优于B组(P<0.05或P<0.01)。结论 在肥胖多学科门诊联合移动医疗APP辅助体重管理利于超重或肥胖患者有效减重，并改善体成分及肥胖相关代谢指标。     

单纯性肥胖儿童血清瘦素水平分析

目的分析单纯性肥胖儿童血清瘦素水平,探讨儿童肥胖发病机制。方法单纯性肥胖儿童33例,正常对照组43例,两组儿童均测标准身高、体重、计算体重指数(BMI),采用放射免疫分析法检测血清瘦索(leptin)水平。结果肥胖组儿童血清瘦素水平及BMI均值明显升高,与正常对照组间差异有显著性(P＜0．05)。结论单纯性肥胖儿童存在高瘦素血症,亦存在瘦素抵抗现象。     

Relationship of obesity to adverse events in myocardial infarction patients without primary percutaneous coronary intervention: results from the Occluded Artery Trial (OAT)

Objective: Our goal was to investigate the “obesity paradox” in myocardial infarction populations without primary percutaneous coronary intervention (PPCI).

Methods: The Occluded Artery Trial (OAT, Clinicaltrials.gov: NCT00004562) is a randomized, multicenter study to investigate the influence of routine percutaneous coronary intervention (PCI) on the clinical outcomes of myocardial infarction patients without PPCI. We stratified these patients into three groups according to body mass index (BMI): normal, 18.5?kg/m²?≤?BMI?<?25?kg/m²; overweight, 25?kg/m²?≤?BMI?<?30?kg/m²; obese, BMI?≥?30?kg/m². The purpose of our study was to investigate the effects of BMI on the primary endpoint (all-cause mortality) and the secondary endpoint (cardiac death, non-cardiac death or New York Heart Association [NYHA] class IV heart failure) in the population enrolled in the OAT.

Results: A total of 2153 patients (99.4%) constituted the final study population. We found that obese patients were younger and were more likely to have cardiovascular risk factors compared with other BMI groups. A U-shaped relationship was observed between BMI and all-cause mortality. The adjusted hazard ratios (HRs) were 0.892 (95% CI: 0.658–1.210, p?=?.460) for normal weight patients and 0.671 (95% CI: 0.508–0.888, p?=?.013) for overweight patients compared with obese patients. The same pattern was also observed for non-cardiac death. The adjusted HRs were 0.919 (95% CI: 0.601–1.40, p?=?.663) for normal weight patients and 0.524 (95% CI: 0.346–0.792, p?=?.004) for overweight patients compared with obese patients. We did not find any statistical differences among BMI categories in terms of cardiac death or NYHA class IV heart failure.

Conclusions: A U-shaped relationship was observed between BMI and all-cause mortality or non-cardiac death. Overweight patients have the lowest risk of all-cause mortality, which may be attributed to their having the lowest risk of non-cardiac death of the groups studied.     

体质量指数与接受成人脂肪肝供体的肝移植术后糖尿病关系探讨#br#

目的　探讨体质量指数（BMI）与接受成人脂肪肝供体的肝移植术后新发糖尿病（NODAT）的关系。方法　对接受成人脂肪肝供体的肝移植术的181例患者资料进行回顾性分析,其中消瘦组5例（BMI＜18.5 kg/m2）,正常组82例（18.5 kg/m2≤BMI＜24 kg/m2）,超重组65例（24 kg/m2≤BMI＜28 kg/m2）,肥胖组29例（BMI≥28 kg/m2）。又根据患者有无NODAT,分为NODAT组57例和非NODAT组124例。比较各组受体的一般资料、术后并发症的差异。利用二元Logistic回归分析影响脂肪肝供体肝移植NODAT的危险因素,并绘制Kaplan-Meier生存曲线对患者肝移植术后1、3、5年累积生存率进行分析。结果　肥胖组术前血清白蛋白低于正常组和超重组（P＜0.05）;超重组和肥胖组患者NODAT发生率高于正常组（P＜0.01）,肥胖组患者NODAT发生率高于消瘦组和超重组（P＜0.05）;二元Logistic回归分析示,超重（OR=3.423,95%CI：1.410~8.310）和肥胖（OR=16.808,95%CI：6.023~46.907）是脂肪肝供体肝移植NODAT发生的独立危险因素;生存曲线显示,肥胖组5年累积生存率明显低于其他3组（Log-rank χ2=44.998,P＜0.01）。结论　超重和肥胖是成人脂肪肝供体肝移植NODAT发生的危险因素,术前合理控制患者BMI可显著改善移植预后。 关键词：人体质量指数;肝移植;糖尿病;移植术后新发糖尿病;脂肪肝供体肝移植     

Are physicians able to identify high-risk abdominally obese individuals? An analysis from the pan-European Survey of HDL‑cholesterol

ABSTRACT

Objectives: Physician perception of the obesity status may influence the approach to the management of cardiometabolic risk factors. The objective of this study was to explore physicians’ perceptions of the obesity status of their patients in comparison with objective measurements of generalised or abdominal obesity.

Research design and methods: The pan-European Survey of high density lipoprotein (HDL)-cholesterol measured the prevalence of low HDL-cholesterol and other cardiometabolic risk factors in 8545 patients in 11 European countries. The survey also included a question, ‘Is your patient obese?’ with possible answers of ‘Yes’ or ‘No’. Answers to this question were compared with actual obesity status, based on standard cut-off values for body mass index (BMI) and waist circumference.

Main outcome measures: Sensitivity and specificity of physicians’ identification of obesity using receiver operating characteristics analysis.

Results: All patients identified as non-obese were subsequently found to have BMI <?30?kg/m². However, 38% of patients identified as obese by physicians did not have BMI ≥?30?kg/m². It appeared that the presence of abdominal obesity (high waist circumference, present according to US criteria in about half of overweight patients) increased the likelihood of a patient being perceived as obese.

Conclusions: Physicians often overestimate obesity, especially in abdominally overweight patients. In practice, physicians tend to identify as obese a subset of patients at higher cardiovascular risk through high waist circumference.     

非布司他对比别嘌醇治疗痛风患者心血管不良事件及死亡风险的Meta分析

目的:对非布司他相比别嘌醇用于治疗痛风患者的心血管不良事件及死亡风险做Meta分析.方法:计算机检索PubMed、EMbase、Cochrane Library(2020年第1期)、CNKI、CBM、VIP、Wanfang数据库,搜集非布司他对比别嘌醇用于治疗痛风患者的随机对照试验(RCT),检索时限均从建库至2020...     

Associations between body mass index and substance use disorders differ by gender: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol, illicit drugs, and nicotine can affect appetite and body weight, but few epidemiologic studies have examined relationships between body mass index (BMI) and substance use disorders. This study used logistic regression to examine effects of BMI and gender on risk for DSM-IV substance use disorders in a sample of 40 364 adults. Overweight and obesity were associated with increased risk for lifetime alcohol abuse and dependence in men but not women. Overweight and obesity were associated with decreased risk for past-year alcohol abuse in women. BMI was not associated with illicit drug use disorders. Overweight and obese men were at decreased risk for both lifetime and past-year nicotine dependence. Overweight women were at increased risk for lifetime nicotine dependence, and obese women were at decreased risk for past-year nicotine dependence. Further research is needed to identify reasons for observed gender differences in relationships between BMI and substance use disorders.     

糖尿病对急性心肌梗死患者PCI术后远期生存的影响

目的 探究糖尿病对急性心肌梗死(acute myocardial infarction,AMI)患者行经皮冠状动脉介入治疗(PCI)术后远期全因死亡和心源性死亡的影响.方法 对2006年1月-12月确诊为AMI,并行PCI治疗的473例患者进行随访,随访截止日期为2015年12月,主要终点事件为全因死亡,次要终点事件为心源性死亡.采用多因素Cox回归分析影响患者生存的相关危险因素.根据患者是否患糖尿病及入院时的糖化血红蛋白(HbA1c)水平,将患者分为3组,无糖尿病者为A组298例,患糖尿病且HbA1c＜6.5％者为B组53例,患糖尿病且HbA1c≥6.5％者为C组102例.比较3组患者远期全因死亡率和心源性死亡率的差异.结果 C组10年全因死亡率和心源性死亡率明显高于A组和B组(P＜0.01);A组和B组上述指标比较差异无统计学意义(P＞0.05).左心室射血分数＞50％、服用他汀类、血管紧张素转化酶抑制剂或血管紧张素受体阻断剂类药物为PCI治疗AMI患者远期预后的保护因素(P＜0.01,P ＜0.05).年龄、吸烟、糖尿病病史、高血压病史、脑卒中病史和心肌梗死病史均为PC1治疗AMI患者远期预后的危险因素(P＜0.01,P＜0.05),其中有糖尿病史患者的死亡风险是非糖尿病患者的1.731倍.结论 合并糖尿病的AMI患者PCI术后远期预后较非糖尿病患者差,提示强化降糖治疗可能会改善其远期预后.     

Impact of different grades of body mass index on left ventricular structure and function

Overweight and obesity influences left ventricular structure and function. WHO Western Pacific Region in 2000 recommended lower cutoff for overweight (Body Mass Index-BMI > or = 23.0) and obesity (Body Mass Index-BMI > or = 25.0) in Asians. However, studies considering the new recommendations of body mass index (BMI) are lacking. The present study investigated the impact of different grades of BMI on left ventricular structure and systolic and diastolic function in middle aged Indian men. The study involved 74 men aged 31 to 60 (mean age 45.24 +/- 10.9) years who were grouped according to BMI as normal weight (18.5-22.9 kg/m2, n=19), overweight (23-24.9 kg/m2, n=17) and obese (> or =25 kg/m2, n=38). Left ventricular structure and function were evaluated by 2-D doppler echocardiography. Compared to normal and overweight, obese had significantly higher left ventricular mass (P < 0.05) and left atrial diameter (P < 0.01). Left ventricular diastolic function (atrial filling velocity-A) showed a significant decline in obese and even in overweight compared to normal (P < 0.05). Left ventricular systolic function showed no significant changes with increase in BMI. Left ventricular diastolic function decreases in all grades of BMI more than 23 kg/m2, whereas structural changes are present only in obese (BMI > or =25 kg/m2). Hence the revised BMI cut-off for Asians as recommended by WHO need to be considered for assessing cardiovascular risk and mortality among Indian men and more stringent control of body weight especially abdominal obesity is justified in the maintenance of cardiovascular health and functional capacity.     

超重或肥胖与不同肝功能指标间的关系研究

目的：研究超重或肥胖与不同肝功能指标间的关系。方法：在体检人群中选择192例受检者，分别测量身高、体重、血压，检测血脂、血糖、肝功能相关多项指标。结果：超重或肥胖者表现出多项代谢异常，包括：血压升高、血糖升高、血脂紊乱。与正常体重组比较，超重或肥胖组的肝功能相关血清酶水平均出现显著的升高（P〈0.05）。调整年龄和性别变量后的多因素回归分析提示，超重或肥胖组谷丙转氨酶异常发生的危险性是正常体重组的2.405倍，95% CI （清除率）为1.121～5.157。结论：超重或肥胖与肝功能相关血清酶水平升高相关。     

Being overweight or obese as a risk factor for acute liver injury secondary to acute acetaminophen overdose

Purpose

Increased incidences of hepatotoxicity have been observed in obese patients with acute acetaminophen overdose. We evaluate whether the status of being overweight or obese is associated with increase in the development of hepatotoxicity and acute liver injury (ALI) in patients with acute acetaminophen overdose.

Methods

This was a retrospective cohort study comparing the risk of hepatotoxicity and ALI between overweight or obese patients (body mass index [BMI] ≥ 25) and normal BMI patients (BMI ≤ 24.9) presenting with acute acetaminophen overdose at Siriraj Hospital during January 2004 to June 2012. All patients were treated with intravenous N‐acetylcysteine. Psi parameters were calculated. High psi was defined as psi of ≥5.0 mM‐hour. Data were analyzed using multinomial logistic regressions, odds ratio (OR), stratified OR, and 95% confidence interval (CI).

Results

There were 197 patients who fulfilled the criteria for analysis, 35 (17.8%) were obese, 24 (12.2%) were overweight, and 138 (70%) were normal BMI cases. Hepatotoxicity and ALI developed in 25 (12.7%) and 40 (20.3%) cases, respectively. Multinomial logistic regression revealed that the overweight‐obesity status and log₁₀(psi value) were significant risk factors of ALI, with OR (95% CI) of 2.68 (1.21‐5.95) and 1.74 (1.27‐2.38), respectively, while only log₁₀(psi) was a significant risk factor of hepatotoxicity with OR (95% CI) 378.51 (39.49‐3627.99). From stratification, overweight‐obesity had significant odds ratios for ALI in strata with low acetaminophen concentration, early initiation of N‐acetylcysteine and low psi.

Conclusion

We conclude that being overweight or obese is an independent risk factor of ALI in acute acetaminophen overdoses.