体重指数对心力衰竭患者抑郁症状与健康结局之间关联的影响。
The Impact of Body Mass Index on the Link Between Depressive Symptoms and Health Outcome in Patients With Heart Failure.
作者信息
Song Eun Kyeung, Moser Debra K, Dekker Rebecca L, Lennie Terry A
机构信息
Eun Kyeung Song, PhD, RN Associate Professor, Department of Nursing, College of Medicine, University of Ulsan, South Korea. Debra K. Moser, DNSc, RN, FAAN Professor, College of Nursing, University of Kentucky, Lexington. Rebecca L. Dekker, PhD, APRN Assistant Professor, College of Nursing, University of Kentucky, Lexington. Terry A. Lennie, PhD, RN, FAAN Professor and Associate Dean, PhD Studies, College of Nursing, University of Kentucky, Lexington.
出版信息
J Cardiovasc Nurs. 2015 Nov-Dec;30(6):529-36. doi: 10.1097/JCN.0000000000000196.
BACKGROUND
Depressive symptoms are predictors of shorter cardiac event-free survival, whereas increased body mass index (BMI) is associated with longer cardiac event-free survival in patients with heart failure (HF). However, the impact of BMI on the link between depressive symptoms and cardiac event-free survival is unexplored. The purpose of this study was to determine whether the relationship between depressive symptoms and cardiac event-free survival differs among HF patients stratified by BMI tertiles.
METHODS
A total of 297 outpatients with HF completed the Patient Health Questionnaire-9 to assess depressive symptoms. Body mass index was calculated as weight in kilograms divided by height in meters squared. Patients were followed for 1 year to determine cardiac event-free survival. Cox proportional hazard regression with survival curves was used to determine the relationships among depressive symptoms, BMI, and cardiac event-free survival.
RESULTS
Both depressive symptoms (P < .001) and lower BMI (P = .002) are independent predictors of shorter cardiac event-free survival after controlling for age, gender, etiology, total comorbidity scores, ejection fraction, New York Heart Association functional class, and prescribed medications. Patients with depressive symptoms had shorter cardiac event-free survival compared with patients without depressive symptoms in the lowest (P = .001) and middle (P = .036) BMI tertiles. There was no difference in cardiac event-free survival between patients with and without depressive symptoms in the highest tertile (P = .894).
CONCLUSIONS
Higher BMI has a protective role in the adverse effect of depressive symptoms on health outcomes in patients with HF.
背景
抑郁症状是心脏无事件生存期较短的预测因素，而体重指数（BMI）升高与心力衰竭（HF）患者较长的心脏无事件生存期相关。然而，BMI对抑郁症状与心脏无事件生存期之间联系的影响尚未得到探讨。本研究的目的是确定在按BMI三分位数分层的HF患者中，抑郁症状与心脏无事件生存期之间的关系是否存在差异。
方法
共有297例HF门诊患者完成了患者健康问卷-9以评估抑郁症状。BMI计算为体重（千克）除以身高（米）的平方。对患者进行1年随访以确定心脏无事件生存期。采用Cox比例风险回归和生存曲线来确定抑郁症状、BMI和心脏无事件生存期之间的关系。
结果
在控制年龄、性别、病因、总合并症评分、射血分数、纽约心脏协会功能分级和处方药物后，抑郁症状（P <.001）和较低的BMI（P =.002）都是心脏无事件生存期较短的独立预测因素。在最低（P =.001）和中间（P =.036）BMI三分位数中，有抑郁症状的患者与无抑郁症状的患者相比，心脏无事件生存期较短。在最高三分位数中，有抑郁症状和无抑郁症状的患者之间的心脏无事件生存期没有差异（P =.894）。
结论
较高的BMI对HF患者抑郁症状对健康结局的不利影响具有保护作用。
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