肥胖对左心室质量的影响：320层多层螺旋计算机断层扫描的结果

Effect of Obesity on Left Ventricular Mass: Results from 320 Multi-Slices Computed Tomography.

作者信息

Jongjirasiri Sutipong, Waeosak Phanloet, Laothamatas Jiraporn, Sritara Chanika, Saengruang-Orn Supakajee

出版信息

J Med Assoc Thai. 2017 Feb;100(2):219-29.

Abstract

OBJECTIVE

To determine effects of obesity and gender on left ventricular mass in normotensive and hypertensive Thai patients using 320-slice cardiac computed tomography (CT).

MATERIAL AND METHOD

Left ventricular mass (LVM) obtained from 320-slice coronary CT angiogram was compared in 597 normotensive subjects (175 men [65 obese] and 422 women [133 obese], aged 55±7 years) and 483 hypertensive patients (180 men [104 obese] and 303 women [170 obese], aged 60±7 years). Obesity in Asian population was defined by body mass index (BMI) ≥ 25 kg/m2 in both genders. LV mass was normalized for body surface area (BSA)and height2.7.

RESULTS

The upper normal limit of LVM/ height2.7 developed from 244 (197 women, 47 men) low risk subjects (non-smoking normal-weight adults free from hypertension, diabetes, coronary artery disease & dyslipidemia) was lower than the established criteria for left ventricular hypertrophy (LVH) (31 versus 44 g/m2.7 in women; 36 versus 48 g/m2.7 in men). There is statistical difference between men and women in all groups of analysis. Among both hypertensive and normotensive subjects, the prevalence of LVH and LVM/height2.7 are higher in the obese group than normal-weight group in both genders (LVM/height2.7p<0.001; prevalence of LVH – obese versus normal-weight hypertension: 58% versus 34% in women, 43% versus 14% in men; obese versus normal-weight normotension: 35% versus 16% in women, 40% versus 15% in men). The same differences between obese and normal-weight groups were also present when normalizing LVM for height but not with LVM/BSA. Logistic regression analysis revealed that systolic blood pressure and BMI were the main predictors of LVH in the entire population (p<0.001 in both genders). Equations for predicting LVH in men and women were: Risk of LVH = 1/(l+e-w) where w is as follows: w (men) = 0.02* systolic pressure + 0.25BMI – 9.86, w (women) = 0.03 systolic pressure + 0.17*BMI – 8.82.

CONCLUSION

Obesity is an independent stimulus to increase LVM in normo-tensive subjects, and its effect is additive in hypertensive patients. Gender and obesity affect LVM and prevalence of LVH.

摘要

目的

使用320层心脏计算机断层扫描（CT）确定肥胖和性别对血压正常及高血压泰国患者左心室质量的影响。

材料与方法

比较了597名血压正常受试者（175名男性[65名肥胖者]和422名女性[133名肥胖者]，年龄55±7岁）和483名高血压患者（180名男性[104名肥胖者]和303名女性[170名肥胖者]，年龄60±7岁）通过320层冠状动脉CT血管造影获得的左心室质量（LVM）。亚洲人群中的肥胖定义为男女体重指数（BMI）均≥25 kg/m²。左心室质量按体表面积（BSA）和身高².⁷进行标准化。

结果

从244名（197名女性，47名男性）低风险受试者（不吸烟、体重正常、无高血压、糖尿病、冠状动脉疾病和血脂异常的成年人）得出的LVM/身高².⁷的正常上限低于既定的左心室肥厚（LVH）标准（女性为31对44 g/m².⁷；男性为36对48 g/m².⁷）。在所有分析组中，男性和女性之间存在统计学差异。在高血压和血压正常的受试者中，肥胖组的LVH患病率和LVM/身高².⁷均高于正常体重组（LVM/身高².⁷ p<0.001；LVH患病率 - 肥胖与正常体重高血压：女性为58%对34%，男性为43%对14%；肥胖与正常体重血压正常：女性为35%对16%，男性为40%对15%）。当按身高对LVM进行标准化时，肥胖组和正常体重组之间也存在相同差异，但按LVM/BSA标准化时则不存在。逻辑回归分析显示，收缩压和BMI是整个人群中LVH的主要预测因素（男女均p<0.001）。预测男性和女性LVH的方程为：LVH风险 = 1/(1+e-w)，其中w如下：w（男性）= 0.02×收缩压 + 0.25×BMI - 9.86，w（女性）= 0.03×收缩压 + 0.17×BMI - 8.82。