Min Jeff, Feng Rui, Badesch David, Berman-Rosenzweig Erika, Burger Charles, Chakinala Murali, De Marco Teresa, Feldman Jeremy, Hemnes Anna, Horn Evelyn M, Lammi Matthew R, Mathai Stephen, McConnell John W, Presberg Kenneth, Robinson Jeffrey, Sager Jeffrey, Shlobin Oksana A, Simon Marc, Thenappan Thenappan, Ventetuolo Corey, Al-Naamani Nadine
University of Pennsylvania, 6572, Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania, United States.
University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States.
Ann Am Thorac Soc. 2020 Oct 21;18(2):229-37. doi: 10.1513/AnnalsATS.202006-612OC.
Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood.
To assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH.
We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status.
767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively).
In a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients.
肥胖与肺动脉高压（PAH）相关，但其对健康相关生活质量（HRQoL）、住院率和生存率等结局的影响尚未完全明确。
评估肥胖对PAH患者健康相关生活质量、住院率和生存率的影响。
我们对肺动脉高压协会注册中心的成年PAH患者进行了一项队列研究，该注册中心是一个前瞻性多中心注册机构。使用多元线性混合效应回归，通过简短健康调查问卷-12（SF-12）和肺动脉高压重点-10问卷（e10）来研究体重类别与HRQoL之间的关系。我们使用多变量负二项回归来估计住院发病率比（IRR），并使用Cox回归来估计按体重状况划分的无移植生存率的风险比（HR）。
纳入767名受试者，平均年龄57岁，74%为女性，33%超重，40%肥胖，中位随访时间为527天。超重和肥胖患者的基线e10评分较高（HRQoL较差），且这种情况随时间持续存在（p<0.001）。与正常体重患者相比，超重和肥胖患者的住院率有增加趋势（IRR分别为1.34，95%置信区间（95%CI）0.94 - 1.92和1.33，95%CI 0.93 - 1.89）。与正常体重患者相比，超重和肥胖患者移植或死亡的风险较低（HR分别为0.45，95%CI 0.25 - 0.80和0.39，95%CI 0.22 - 0.70）。
在一个大型多中心前瞻性PAH队列中，与正常体重患者相比，超重和肥胖患者尽管无移植生存率较好，但疾病特异性HRQoL较差。未来的干预措施应满足这些患者的特殊需求。
