糖尿病患者心力衰竭住院后的体重与死亡率。
Weight and mortality following heart failure hospitalization among diabetic patients.
机构信息
Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
出版信息
Am J Med. 2011 Sep;124(9):834-40. doi: 10.1016/j.amjmed.2011.04.030.
BACKGROUND
Type 2 diabetes is an important risk factor for heart failure and is common among patients with heart failure. The impact of weight on prognosis after hospitalization for acute heart failure among patients with diabetes is unknown. The objective of this study was to examine all-cause mortality in relation to weight status among patients with type 2 diabetes hospitalized for decompensated heart failure.
METHODS
The Worcester Heart Failure Study included adults admitted with acute heart failure to all metropolitan Worcester medical centers in 1995 and 2000. The weight status of 1644 patients with diabetes (history of type 2 diabetes in medical record or admission serum glucose ≥200 mg/dL) was categorized using body mass index calculated from height and weight at admission. Survival status was ascertained at 1 and 5 years after hospital admission.
RESULTS
Sixty-five percent of patients were overweight or obese and 3% were underweight. Underweight patients had 50% higher odds of all-cause mortality within 5 years of hospitalization for acute heart failure than normal weight patients. Class I and II obesity were associated with 20% and 40% lower odds of dying. Overweight and Class III obesity were not associated with mortality. Results were similar for mortality within 1 year of hospitalization for acute heart failure.
CONCLUSIONS
The mechanisms underlying the association between weight status and mortality are not fully understood. Additional research is needed to explore the effects of body composition, recent weight changes, and prognosis after hospitalization for heart failure among patients with diabetes.
背景
2 型糖尿病是心力衰竭的一个重要危险因素，在心力衰竭患者中较为常见。糖尿病患者因急性心力衰竭住院后，体重对预后的影响尚不清楚。本研究旨在探讨因失代偿性心力衰竭住院的 2 型糖尿病患者的体重状况与全因死亡率之间的关系。
方法
伍斯特心力衰竭研究纳入了 1995 年和 2000 年所有伍斯特大都市医疗中心因急性心力衰竭入院的成年人。1644 例糖尿病患者（病历中有 2 型糖尿病史或入院时血清葡萄糖≥200mg/dL）的体重状况采用入院时身高和体重计算的体重指数进行分类。在入院后 1 年和 5 年确定生存状况。
结果
65%的患者超重或肥胖，3%的患者体重不足。与体重正常的患者相比，体重不足的患者在因急性心力衰竭住院后 5 年内全因死亡的风险高 50%。I 级和 II 级肥胖与死亡风险降低 20%和 40%相关。超重和 III 级肥胖与死亡率无关。急性心力衰竭住院后 1 年内的死亡率也有类似结果。
结论
体重状况与死亡率之间的关联的机制尚不完全清楚。需要进一步研究来探讨糖尿病患者的身体成分、近期体重变化以及心力衰竭住院后的预后对死亡率的影响。
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