冠心病介入治疗后“肥胖矛盾”现象的Meta分析

目的探讨冠心病(CAD)患者经皮冠状动脉介入(PCI)治疗术后中是否存在"肥胖矛盾现象"。方法选择既往以肥胖作为危险因素,与CAD患者PCI术后全因死亡及心脏性死亡的队列研究,随访至少12个月。根据体重指数(BMI)将患者分为:低体重、正常体重、超重、肥胖及重度肥胖五组。结果检索到12个研究,入选患者24 585例,平均随访2.6年,BMI正常的CAD患者PCI术后总死亡率较肥胖组增加(OR=1.42,95%CI 1.27-1.58),而心脏源性死亡呈增加趋势(OR=1.21,95%CI 0.86-1.72)。结论合并肥胖的CAD患者PCI术后长期随访有着较低的全因死亡及心脏性死亡;患者PCI术后存在肥胖矛盾现象,提示应寻找能更准确的方法评价CAD患者机体脂肪过多的议题。

A Meta analysis on the obesity paradox in patients with coronary heart disease after PCI therapy

Objective To investigate the ’obesity paradox’ phenomenon in coronary heart disease(CAD) patients after percutaneous coronary intervention(PCI) therapy.Methods The pooled cohort studies that provided risk estimates for all-cause mortality and cardiac mortality were collected.On the basis of body mass index(BMI),the CAD patients were divided into 5 groups of low,normal,overweight,obese and severely obese.The patients were followed-up for at least 12 months.ResultsTwelve studies with 24 585 cases with mean follow-up time of 2.6 years were included in this Meta analysis.Compared with the obesity,the patients with normal BMI had an increased relative risk for total mortality(OR=1.42,95%CI 1.27-1.58) and the tendency of increased risk for cardiac mortality(OR=1.21,95%CI 0.86-1.72).Conclusion Compared to the patients with normal BMI,the all-cause mortality and cardiovascular mortality are lower in the obese patients after PCI,suggesting that the obesity paradox does exist and the alternative measures should be searched for reasonably evaluating the excess of body fat.