JACC：西班牙研究，营养不良提示心梗患者预后差！

2020-08-14 朱朱中国循环杂志

XujieL

西班牙学者发表在JACC上的一项研究提示，在急性冠脉综合征患者中，营养不良很常见，而营养不良显著增加死亡和主要不良心血管事件发生风险。

西班牙学者发表在JACC上的一项研究提示，在急性冠脉综合征患者中，营养不良很常见，而营养不良显著增加死亡和主要不良心血管事件发生风险。

DOI：10.1016/j.jacc.2020.06.058

本刊之前也有研究发现，大部分急性心肌梗死介入术后处于营养不良状态，营养状态可以作为心梗患者死亡的独立预测因子。

研究者指出，评估急性冠脉综合征患者的营养状况有助于找出预后不良的患者，而且营养不良是急性冠脉综合征患者的可调节危险因素，临床医生可对营养不良的患者进行营养干预，出院后在康复中心可继续干预。

述评专家指出，对于营养不良的患者，临床医生要给予充分的教育，让患者知晓基本的营养概念，这样有助于降低死亡风险。

该研究说明，现在是心血管医生用最有费用效益的有力工具与心血管病斗争的时候了，这两个工具就是：营养和生活方式医学。

研究者发现，根据控制营养状态（CONUT）评分、营养风险指数（NRI）、营养预后指数（PNI）三个营养评估指标，急性冠脉综合征患者中分别有11.2%、39.5%、8.9%存在中度或重度营养不良，71.8%的患者至少存在轻度营养不良。

中位随访3.6年期间，16.4%的患者死亡，20.7%的患者发生主要不良心血管事件（心血管死亡、再次心肌梗死、缺血性中风）。

与营养状态良好的患者相比，营养不良的患者全因死亡风险明显增加。

根据CONUT评分、NRI、PNI评估的中度营养不良患者，全因死亡风险分别增加1.02倍、40%、71%，重度营养不良患者全因死亡风险分别增加2.65倍、1.87倍、95%。

根据CONUT评分、NRI、PNI评估的中度和重度营养不良患者中，主要不良心血管事件发生风险也显著增加。

研究者还发现，在GRACE评分的基础上，如果加入上述三个营养评估指标，其对急性冠脉综合征患者长期死亡和主要不良心血管事件风险的预测能力明显提高。

值得注意的是，尽管营养评分较差与体重指数较低强烈相关，但在该研究中，根据不同的营养评估指标，超重或肥胖（体重指数≥25 kg/m²）的急性冠脉综合征患者中8.4%~36.7%存在中度或中度营养不良。

述评专家指出，这提示临床医生，即便是超重或肥胖的患者也有可能存在营养不良的现象，不要忽视对其营养状态的评估。

该研究共纳入5062例急性冠脉综合征患者，中位年龄为66岁。

原始出处：Sergio Raposeiras Roubín, Emad Abu Assi, María Cespón Fernandez, et al. Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome. J Am Coll Cardiol, 7, August 2020.

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2021-06-25 蓝色贝鱼88

#心梗#来学习

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2020-12-28 hbwxf

#JACC#

37 0
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2021-05-18 bnurmamat

#患者预后#

44 0
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2021-01-10 lovetcm

#心肌梗死##心梗#

158 0
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2021-04-13 zhanglin3079

#心梗患者#

27 0
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2020-08-27 14818eb4m67暂无昵称

学习了

0 0
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2020-08-16 12498568m50暂无昵称

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