Ferreira Joana, Campos Jacinta, Braga Sandrina, Sousa Pedro, Simões João, Carrilho Celso, Canedo Alexandra, Mesquita Amílcar
Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Serviço de Angiologia e Cirurgia Vascular, Hospital Da Senhora Da Oliveira, Guimarães, Portugal.
Rev Port Cir Cardiotorac Vasc. 2020 Apr-Jun;27(2):111-116.
OBJECTIVE/BACKGROUND: Peripheral artery disease (PAD) is an important manifestation of systemic atherosclerosis. Obesity is a risk factor for atherosclerosis and for cardiovascular events. However, the relationship between obesity and PAD is unclear. We hypothesized that anthropometric measures of adiposity, in particularly of central obesity will be associated with PAD severity, in patients undergoing aorto-bifemoral bypass.
A prospective observation study was conducted. From 2009 and 2012 a total of 46 males who underwent aorto-bifemoral bypass were enrolled prospectively. 17 with intermittent claudication (IC) and 29 with chronic limb threatening ischemia (CLTI). They were followed for 5 years. The anthropometric measures, weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and the seric levels of hemoglobin, triglycerides, and albumin were recorded. The mortality and cardiovascular events in following five years were also registered.
The groups did not differ in the mean age (IC 60.69±7.46 versus CLTI 64.51 ±8.42 years, p=0.712), diabetes (IC 18% versus CLTI 45%, p=0.06), hypertension (IC 70% versus CLTI 52%, p=0.21), hypercholesterolemia (IC 18% versus CLTI 45%, p=0.47) and smoking habits prevalence (IC 100% versus CLTI 86%, p=0.11). The anthropometric measures: weight, WC and WHR were significant lower in CLTI compared to IC patients (IC 72.74±9.84 Kg versus CLTI 65.92±10.89 Kg, p=0.043; IC 98.65±8.19 cm versus CLTI 89.38±15.91 cm, p=0.017; IC 1.06±0.06 versus CLTI 1.01±0.06, p=0.038). The serum levels of hemoglobin, albumin and triglycerides were also lower in CLTI patients (IC 14,40±1.63g/dL versus CLTI 13.3±1.89g/dL, p=0.048; IC 4.6±0.81g/dL versus CLTI 4.3± 0.67g/dL, p=0.007; IC 212±95.60mg/Dl versus CLTI 111±41.53 mg/dL, p=0.001). No relation was found between the anthropometric measures at admission and the cardiovascular events or mortality at five years.
CLTI patients had lower anthropometric measures of obesity, when compared to IC patients. These results could be explained by the fact that CLTI patients with severe atherosclerotic disease are in a state of chronic inflammation, with consequent cardiometabolic demands and catabolism.
目的/背景：外周动脉疾病（PAD）是全身动脉粥样硬化的重要表现。肥胖是动脉粥样硬化和心血管事件的危险因素。然而，肥胖与PAD之间的关系尚不清楚。我们推测，在接受主-双股动脉旁路移植术的患者中，肥胖的人体测量指标，尤其是中心性肥胖指标，将与PAD严重程度相关。
进行了一项前瞻性观察研究。2009年至2012年，共有46例接受主-双股动脉旁路移植术的男性患者被前瞻性纳入研究。其中17例为间歇性跛行（IC）患者，29例为慢性肢体威胁性缺血（CLTI）患者。对他们进行了5年的随访。记录了人体测量指标，包括体重、体重指数（BMI）、腰围（WC）、腰臀比（WHR）以及血红蛋白、甘油三酯和白蛋白的血清水平。还记录了随后五年内的死亡率和心血管事件。
两组患者在平均年龄（IC组60.69±7.46岁，CLTI组64.51±8.42岁，p=0.712）、糖尿病（IC组18%，CLTI组45%，p=0.06）、高血压（IC组70%，CLTI组52%，p=0.21）、高胆固醇血症（IC组18%，CLTI组45%，p=0.47）和吸烟习惯患病率（IC组100%，CLTI组86%，p=0.11）方面无差异。与IC患者相比，CLTI患者的人体测量指标：体重、WC和WHR显著更低（IC组72.74±9.84千克，CLTI组65.92±10.89千克，p=0.043；IC组98.65±8.19厘米，CLTI组89.38±15.91厘米，p=0.017；IC组1.06±0.06，CLTI组1.01±0.06，p=0.038）。CLTI患者的血红蛋白、白蛋白和甘油三酯血清水平也更低（IC组14.40±1.63克/分升，CLTI组13.3±1.89克/分升，p=0.048；IC组4.6±0.81克/分升，CLTI组4.3±0.67克/分升，p=0.007；IC组212±95.60毫克/分升，CLTI组111±41.53毫克/分升，p=0.001）。入院时的人体测量指标与五年后的心血管事件或死亡率之间未发现关联。
与IC患者相比，CLTI患者的肥胖人体测量指标更低。这些结果可以用以下事实来解释：患有严重动脉粥样硬化疾病的CLTI患者处于慢性炎症状态，从而导致心脏代谢需求和分解代谢。
