2019 年第 2 期 第 14 卷

腰臀比和腰围与择期冠状动脉介入治疗患者预后的关系

Relation between waist-to-hip ratio, waist circumference and prognosis of patients undergoing selective percutaneous coronary intervention

作者：王建龙赵迎新刘宇扬翟光耀周玉杰

英文作者：

单位：100029首都医科大学附属北京安贞医院心内十二病房北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心

英文单位：

关键词：经皮冠状动脉介入；肥胖；腰臀比；腰围

英文关键词：

• 摘要：

• 【摘要】目的    探讨腰臀比和腰围与择期冠状动脉介入（PCI）治疗患者预后的关系。方法    连续入选2011年7—12月于首都医科大学附属北京安贞医院经冠状动脉造影证实冠状动脉狭窄超过75%并成功接受择期PCI治疗的患者650例，所有患者入院后即刻完成基础资料的记录及测量，根据腰围测量结果和腰臀比计算结果按照三分位法分别分为3组，比较不同分组患者随访和预后的差异，主要终点为1年内死亡、非致死性心肌梗死、靶血管再次血运重建和卒中，次要终点为心血管事件导致患者再次入院。结果    根据腰臀比计算结果男性腰臀比三等分分割点为0.91及0.97，女性为0.90及0.95，低腰臀比组男性腰臀比≤0.91，女性≤0.90，中腰臀比组男性腰臀比为0.92~0.97，女性为0.91~0.95，高腰臀比组男性腰臀比＞0.97，女性＞0.95。根据腰围测量结果男性腰围三等分分割点为89 cm及96 cm，女性为85 cm及92 cm，低腰围组男性腰围≤89 cm，女性≤85 cm，中腰围组男性腰围90~96 cm，女性86~92 cm，高腰围组男性腰围＞96 cm，女性＞92 cm。高腰臀比组和中腰臀比组血运重建、主要终点事件发生率均高于低腰臀比组［8.9%(19/214)、6.3%(14/224)比2.4%（5/212），13.1%(28/214)、8.9%(20/224)比3.8%（8/212）］，高腰臀比组心血管原因再次住院率高于低腰臀比组和中腰臀比组［19.6%(42/241)比7.5%（16/212）、12.5%（28/224）］，差异均有统计学意义（均P<0.05），生存分析显示高腰臀比组无事件生存率最低（P=0.003）。糖尿病史会增加PCI术后主要终点事件发生风险（风险比=2.04，95%置信区间：1.21~3.45， P<0.001），与低腰臀比组比较，高腰臀比组、中腰臀比组PCI术后主要终点事件发生风险均增加（风险比=3.67，95%置信区间：1.67~8.05，P<0.001；风险比=2.43，95%置信区间：1.07~5.52，P=0.034）。结论    在接受择期PCI的冠心病人群中，使用腰臀比来预测临床预后可能具有一定的应用价值。

• 【Abstract】Objective    To analyze the relation between waist-to-hip ratio(WHR), waist circumference(WC) and prognosis in patients with coronary heart disease(CHD) undergoing selective percutaneous coronary intervention(PCI). Methods    A total of 650 consecutive CHD patients with coronary artery stenosis more than 75% undergoing selective PCI in Beijing Anzhen Hospital, Capital Medical University between July and December 2011 were involved. Baseline characteristics and measurements were collected. All patients were classified into tertiles of WC or WHR. Primary end-points included death, non-fatal myocardial infarction, target vessel revascularization and stroke during the 1st year after procedure. Secondary end-point was cardiovascular readmission. Results    The cutoff values of tertiles of WHR were 0.91 and 0.97 for men, 0.90 and 0.95 for women. The categorization based on WHR in the whole cohort was low WHR group(men: ≤0.91; women： ≤0.90), middle WHR group（men： 0.92-0.97; women: 0.91-0.95）and high WHR group（men: ＞0.97； women： ＞0.95）. The cutoff values of tertiles of WC were 89, 96 cm for men and 85, 92 cm for women. The categorization based on WC was low WC group(men: ≤89 cm; women： ≤85 cm)， middle WC group（men： 90-96 cm; women: 86-92 cm）and high WC group（men: ＞96cm； women：＞92 cm）. Incidences of target vessel revascularization and primary end-point events in the high and middle WHR groups were higher than those in the low WHR group ［8.9%(19/214), 6.3%(14/224) vs 2.4%（5/212）; 13.1%(28/214), 8.9%(20/224) vs 3.8%（8/212）］; incidence of cardiovascular readmission in the high WHR group was higher than that in the middle and low WHR groups［19.6%(42/241) vs 7.5%（16/212）, 12.5%（28/224）］(all P<0.05). Event-free survival rate in the high WHR group was the lowest in survival analysis(P=0.003). Diabetes history was associated with high risk of primary end-point events after PCI(hazard ratio＝2.04; 95% confidence interval: 1.21-3.45, P<0.001). WHR rise was positively related with primary end-point events; the hazard ratio increased in the middle WHR group(hazard ratio＝2.43; 95% confidence interval: 1.07-5.52, P=0.034) and high WHR group(hazard ratio＝3.67; 95% confidence interval: 1.67-8.05, P<0.001). Conclusion    WHR can be a predictive index for the outcome of CHD patients with selective PCI.