CAJ | 학술논문

目的评估肥胖对于小主动脉瓣人工瓣膜(直径≤21 mm)置换术后长期生存率的影响.方法 1998年1月至2008年12月对307例首次接受小号主动脉瓣置换术生存时间超过1个月者进行长期随访.并根据身体质量指数(BMI)划分为3组:BMI＜ 24.0 kg/m2为正常组(185例),BMI 24.0 ～27.9 kg/m2为超重组(94例),BMI≥28 kg/m2为肥胖组(28例).分别在术后第3、6个月,第1、3、5、8年收集NHYA分级,有效瓣口面积指数(EOAI),左心室质量指数(LVMI),左心室射血分数(LVEF)等指标,了解各组中这些指标的变化及组间比较,分析肥胖是否与生存率有关;计算总体死亡率及3组各自死亡率并比较.结果经过单变量和多变量分析,并通过倾向得分调节,肥胖均为影响生存率的独立危险因子(HR:1.62;P =0.01).长期随访中,肥胖组和超重组生存率较正常组低,而且术后NYHAⅢ/Ⅳ级患者所占比例偏高.3组中肥胖组和超重组EOAI偏小,LVMI偏高,均有统计学意义.但LVEF无明显变化.结论肥胖和术后长期生存率密切相关,肥胖和超重均可能降低术后的长期生存率.EOAI可能在其中发挥重要作用,提高EOAI会提高术后长期生存率,改善术后长期生存质量.
목적 평고비반대우소주동맥판인공판막(직경≤21 mm)치환술후장기생존솔적영향.방법 1998년1월지2008년12월대307례수차접수소호주동맥판치환술생존시간초과1개월자진행장기수방.병근거신체질량지수(BMI)화분위3조:BMI＜ 24.0 kg/m2위정상조(185례),BMI 24.0 ～27.9 kg/m2위초중조(94례),BMI≥28 kg/m2위비반조(28례).분별재술후제3、6개월,제1、3、5、8년수집NHYA분급,유효판구면적지수(EOAI),좌심실질량지수(LVMI),좌심실사혈분수(LVEF)등지표,료해각조중저사지표적변화급조간비교,분석비반시부여생존솔유관;계산총체사망솔급3조각자사망솔병비교.결과 경과단변량화다변량분석,병통과경향득분조절,비반균위영향생존솔적독립위험인자(HR:1.62;P =0.01).장기수방중,비반조화초중조생존솔교정상조저,이차술후NYHAⅢ/Ⅳ급환자소점비례편고.3조중비반조화초중조EOAI편소,LVMI편고,균유통계학의의.단LVEF무명현변화.결론 비반화술후장기생존솔밀절상관,비반화초중균가능강저술후적장기생존솔.EOAI가능재기중발휘중요작용,제고EOAI회제고술후장기생존솔,개선술후장기생존질량.
Objective This study was designed to evaluate the effect of obesity on late survival after aortic valve replacement(AVR) in patients with implantation of small aortic prosthesis(size≤21).Methods From January 1998 through December 2008,307 patients in a single center in china underwent primary AVR with smaller prosthesis survive the 30 days of surgery.Patients were defined as normal if body mass index (BM1) ＜ 24.0 kg/m2,as overweight if BMI 24.0-27.9 kg/m2,and as obesity if BMI≥28.0 kg/m2.Data of New York Heart Association(NYHA) Functional class,effective orifice area index (EOAI),left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF) were got at the 3rd month(M),6th M,1 st year(Y),3rd Y,5th Y,8th Y after operation respectively.Results At multivariable analysis,obesity was independent factor of later mortality [hazard ratio (HR):1.62 ; P =0.01].Obesity group and overweight group had poor survival (P ＜0.001)and higher proportion of NYHA Function Ⅲ/Ⅳ (P ＜ 0.01) in long-term compared to normal group.EOAI were lower and LVMI were higher in obesity group and overweight group,but LVEF have no significant difference.Conclusion Obesity is associated with increased late mortality after AVR in patients with implantation of small aortic prosthesis.Obesity and overweight may also affect the NYHA function in long term.EOAI should be improved where possible as it may reduce late mortality and improve life quality in such patients.