Department of Vascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa-city, Gunma Prefecture, Japan.
J Vasc Surg. 2010 Jul;52(1):110-7. doi: 10.1016/j.jvs.2010.02.008. Epub 2010 May 15.
This study analyzed risk factors for mortality in peripheral arterial disease (PAD), including body mass index (BMI) and estimated glomerular filtration rate (eGFR). Risk factors for long-term survival are unclear in patients with PAD. The origin of the obesity paradox, a paradoxical decrease in mortality with increasing BMI, is also uncertain in these patients.
A prospective cohort study was performed in 652 patients (aged 71.3 +/- 9.4 years old) with PAD.
The 1-, 5-, 10- and 15-year survival rates were 94.5%, 70.4%, 45.2%, and 21.1%, respectively, in patients with intermittent claudication, and 72.7%, 27.2%, 11.6%, and 5.8%, respectively, in those with critical limb ischemia (CLI). In Cox multivariate analysis, a significant association with all-cause mortality was found for CLI (hazard ratio [HR], 1.931; 95% confidence interval [CI], 1.089-3.422; P = .024), diabetes (HR, 2.111; 95% CI, 1.247-3.572; P = .005), BMI (HR, 0.879; 95% CI, 0.804-0.962; P = .005), and eGFR (HR, 0.985; 95% CI, 0.971-0.998l; P = .028). These parameters were also significant risk factors for cardiovascular mortality. Fibrinogen (HR, 1.003; 95% CI, 1.001-1.005; P = .014) and cerebrovascular disease (HR, 1.730; 95% CI, 1.021-2.930; P = .045) were identified as risk factors for all-cause mortality. The adjusted HR for mortality of BMI <21.5 vs >or=21.5 kg/m(2) was 1.772 (95% CI, 1.378-2.279; P < .001). BMI had positive correlations with triglyceride and albumin concentrations and negative correlations with the fibrinogen level and chronic obstructive pulmonary disease (P = .005).
Low BMI, eGFR, CLI, and diabetes are significant risk factors for mortality in PAD. The obesity paradox was verified and may be partly explained by low BMI mediated by malnutrition and systemic inflammation due to PAD or chronic obstructive pulmonary disease.
本研究分析了外周动脉疾病（PAD）患者死亡的危险因素，包括体重指数（BMI）和估计肾小球滤过率（eGFR）。PAD 患者的长期生存危险因素尚不清楚。肥胖悖论的起源，即 BMI 增加死亡率反而降低的悖论，在这些患者中也不确定。
对 652 例（年龄 71.3 +/- 9.4 岁）PAD 患者进行前瞻性队列研究。
间歇性跛行患者的 1 年、5 年、10 年和 15 年生存率分别为 94.5%、70.4%、45.2%和 21.1%，而严重肢体缺血（CLI）患者分别为 72.7%、27.2%、11.6%和 5.8%。Cox 多变量分析发现，CLI（危险比[HR]，1.931；95%置信区间[CI]，1.089-3.422；P =.024）、糖尿病（HR，2.111；95%CI，1.247-3.572；P =.005）、BMI（HR，0.879；95%CI，0.804-0.962；P =.005）和 eGFR（HR，0.985；95%CI，0.971-0.998l；P =.028）与全因死亡率显著相关。这些参数也是心血管死亡率的显著危险因素。纤维蛋白原（HR，1.003；95%CI，1.001-1.005；P =.014）和脑血管疾病（HR，1.730；95%CI，1.021-2.930；P =.045）被确定为全因死亡率的危险因素。BMI <21.5kg/m2 与 BMI≥21.5kg/m2 相比，死亡率的调整 HR 为 1.772（95%CI，1.378-2.279；P <.001）。BMI 与甘油三酯和白蛋白浓度呈正相关，与纤维蛋白原水平和慢性阻塞性肺疾病呈负相关（P =.005）。
低 BMI、eGFR、CLI 和糖尿病是 PAD 患者死亡的重要危险因素。肥胖悖论得到了验证，可能部分可以通过 BMI 来解释，BMI 是由于 PAD 或慢性阻塞性肺疾病导致的营养不良和全身炎症引起的。
