非ST段抬高型急性冠状动脉综合征患者的身体组分特点及预后危险因素分析

Analysis of body composition characteristics and prognostic risk factors in patients with non-ST segment elevated acute coronary syndrome

摘要:

目的：探讨非ST段抬高型急性冠状动脉综合征（non-ST segment elevated acute coronary syndrome，NSTEACS）患者的身体组分特点及预后影响因素。方法：以2013年1月至2019年10月符合条件的466例NSTEACS患者为研究对象，收集患者一般临床资料。参与者的身体组分特点通过腹部CT所测脂肪及肌肉判断，并分为对照组、肥胖组、肌少症组和肌少性肥胖组。所有患者进行前瞻性随访，终点事件为主要不良心脏事件（major adverse cardiac event，MACE）。生存率估算应用Kaplan-Meier法，应用多变量Cox比例风险回归分析身体组分和MACE的关系。结果：466例参与者中，对照组106例（22.7%），肥胖组172例（36.9%），肌少症组79例（17.0%），肌少性肥胖组109例（23.4%）。4组之间无MACE生存曲线存在统计学差异（ χ2=30.674，P=0.000）。其中对照组与肥胖组（ χ2=6.099，P=0.014）、对照组与肌少症组（ χ2=9.332，P=0.002）、对照组与肌少性肥胖组（ χ2=27.775，P=0.000）、肥胖组与肌少性肥胖组（ χ2=12.642，P=0.000）、肌少症组与肌少性肥胖组（ χ2=3.972，P=0.046）之间均存在统计学差异，而肥胖组与肌少症组（ χ2=0.948，P=0.330）之间无统计学差异。多因素Cox回归表明，糖尿病、GRACE评分高、肥胖、肌少症、肌少性肥胖是MACE的独立危险因素，而经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）是减少MACE的保护性因素。结论：NSTEACS患者不存在肥胖悖论，肌少性肥胖、肌少症和肥胖均是NSTEACS患者发生心血管事件的危险因素，这有助于对NSTEACS患者进一步危险分层。

Abstract:

Objective：To investigate the characteristics of body components and prognostic factors in patients with non ST segment elevation acute coronary syndrome（NSTEACS）. Methods：This study included 466 NSTEACS patients meeting the conditions between January 2013 and October 2019 General clinical data were collected. Participants’ body composition characteristics were judged by fat and muscle measured by abdominal CT，and they were divided into control group，obesity group，sarcopenia group and sarcopenic obesity group. Prospective follow-up was performed in all patients. The endpoint event was major adverse cardiac event（MACE）. The Kaplan-Meier method was used to estimate the survival rate. Multivariate Cox proportional hazards regression was used to analyze the relationship between body composition and MACE. Results：There were 106 cases（22.7%） in the control group，172 cases（36.9%） in the obese group，79 cases（17.0%） in the sarcopenia group，and 109 cases（23.4%） in the sarcopenic obesity group. There were significant differences in survival curves between the 4 groups（ χ2=30.674，P=0.000）. Survival curves between control group and obe－sity group（χ2=6.099，P=0.014），control group and sarcopenia group（ χ2=9.332，P=0.002），obesity group and sarcopenia group（ χ2=27.775，P=0.000），obesity group and sarcopenic obesity group（ χ2=12.642，P=0.000），sarcopenia group and sarcopenic obesity group（ χ2=3.972，P=0.046） were significant different. There was no significant difference between the obesity group and the sarcopenia group（ χ2=0.948，P=0.330）. Multivariate Cox regression showed that diabetes，high GRACE score，obesity，sarcopenia，and sarcopenic obesity were independent risk factors for MACE，while percutaneous coronary intervention（PCI） was a protective factor for reducing MACE. Conclusion：There is no obesity paradox in patients with NSTEACS. Sarcopenic obesity，sarcopenia and obesity are risk factors for cardiovascular events in NSTEACS patients. The results help to further perform risk stratification for NSTEACS patients.