Objective Chronic obstructive pulmonary disease( COPD) is highly heterogeneous. In theory, the patients with same clinical manifestations, treatment response and prognosis can be classified into one phenotype, which may have same biological or physiological mechanisms. In this study the profiles of patients with COPD including body mass index( BMI) , Goddard score, fractional exhaled nitric oxide( FeNO) were analyzed in order to find some special phenotypes.Methods Patients with COPD at stable stage in Ruijin Hospital from May 2011 to February 2012 were evaluated with COPD assessment test ( CAT) in Chinese version, St. George’s Respiratory Questionnaire( SGRQ) , hospital anxiety and depression( HAD) rating scale, pulmonary function test, and 6-minute walking test ( 6MWT) . Baseline data was collected including height, weight, drug use, times of exacerbation, etc. Results A total of 126 patients were recruited. The patients with low BMI had poorer quality of life, lower FEV1 , poorer diffusion function, and higher Goddard score, and was easier to develop anxiety and depression. The patients with high BMI had lower oxygen saturation at rest. We failed to define a certain kind of phenotype according to FeNO. The patients of emphysema phenotype( assessed by Goddard score) had lower BMI, decreased lung diffusion capacity, and poorer quality of life. Conclusion The study can define COPD patients into some special phenotypes( low BMI and emphysema phenotype) , but failed to define a certain kind of phenotype according to FeNO.
ObjectivesTo systematically review the association between body mass index (BMI) and mortality of chronic obstructive pulmonary disease (COPD).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies on the association between BMI and mortality of COPD from inception to February, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 14 cohort studies involving 494 060 COPD patients were included. The results of meta-analysis showed that, compared with patients having a normal weight, underweight individuals were associated with higher mortality (RR=1.40, 95%CI 1.15 to 1.71, P=0.000 8), whereas overweight (RR=0.65, 95%CI 0.54 to 0.79, P<0.000 1) and obese (RR=0.37, 95%CI 0.20 to 0.67, P=0.001) patients were associated with lower mortality.ConclusionsCurrent evidence shows that underweight is associated with a higher risk of all-cause mortality among patients with COPD, whereas overweight and obese are associated with lower risk of all-cause mortality in these patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
Objective To explore the clinical effects of postoperative restrict rehydration on different body mass index (BMI) of patients with colorectal cancer. Methods From January 2008 to January 2009, the patients diagnosed definitely as colorectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different BMI (underweight group, normal group, overweight group).Results The first defecation time, aerofluxus time and ambulation time of the fluid restriction group were significantly earlier than those of the tradition therapy group (Plt;0.05), and postoperative in-hospital time was also less (Plt;0.05). However, the differences of early postoperative rehabilitation among underweight group, normal group and overweight group in the tradition therapy group and fluid restriction group had no statistical significance (Pgt;0.05). The complications such as pulmonary infection, anastomotic leakage, intestinal obstruction and wound dehiscence in the fluid restriction group were significantly lower than those in the tradition therapy group (Plt;0.05). In the tradition therapy group, the incidences of anastomotic leakage and wound dehiscence in overweight group were significantly higher than those in the underweight and normal group (Plt;0.05). The rate of postoperative complications among underweight group, normal group and overweight group in the fluid restriction group had no statistical significance (Pgt;0.05). Conclusion Postoperative restrict rehydration for overweight colorectal cancer patients has a good clinical effect, which can promote the early postoperative rehabilitation.
【摘要】 目的 探讨体检人群体重指数(BMI)与血糖、血脂的相关性。方法 2007年1月—12月对11 310例在华西医院体检人群进行空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC)检测,同时测量身高、体重,计算BMI,并对相关资料进行统计分析。结果 11 310例体检人群中超重与肥胖的检出率分别为32.8％、8.1％;体重过低、正常、超重、肥胖4组人群的空腹血糖受损(IFG)患病率分别为3.3％、7.2％、17.6％、24.2％,糖尿病(DM)患病率分别为0.6%、2.7%、6.8%、9.8%,高TC患病率分别为7.0％、11.8％、15.7％、16.9％,高TG患病率分别为3.0％、19.6％、47.5％、58.9％,低HDLC患病分别为0.8％、1.7％、8.1％、14.1％,高LDLC患病率分别为2.4％、5.5％、8.0％、8.0％,各组间差异均有统计学意义(P＜005);不同体重指数组的FPG、TC、TG、HDLC、LDLC水平差异均有统计学意义(P＜005)。结论 IFG、DM、高TC、高TG、低HDLC的患病率随着体重指数的增大而显著增高,FPG、TC、TG、LDLC值也随着体重指数的增大而增高。建议通过改变不良生活方式、平衡日常膳食、加强体育锻炼、减轻精神压力、控制体重等方式来干预防治超重和肥胖,减少各种慢性病的发生率。
In this study we performed Tissue Doppler Imaging (TDI), two-dimensional speckle tracking imaging (2D-STI) and three-dimensional speckle tracking imaging (3D-STI) on enrolled healthy, overweight and obese groups (34 subjects in each group), respectively, to analyze cardiac structure and its function. Compared with healthy group, global longitudinal strain (GLS), global circumferential strain (GCS), global area strain(GAS) and global radial strain (GRS) decreased progressively (P＜0.05). The ratio of early diastolic mitral inflow velocity to global early diastolic strain rate of left ventricle (E/e′sr) (r=0.466, P＜0.001), GLS(r=0.502, P＜0.001), GCS(r=0.426, P＜0.001), GAS(r=0.535, P＜0.001) and GRS(r=-0.554, P＜0.001) were correlated with body mass index (BMI). E/e′sr (r=0.37, P=0.003), GLS(r=0.455, P＜0.001), GCS(r=0.282, P=0.02), GAS(r=0.412, P＜0.001) and GRS (r=-0.471, P＜0.001) were correlated with free fatty acid (FFA). Stepwise multiple linear regression revealed that BMI was independently correlated with E/e′sr, GLS, GCS, GAS and GRS. Waist to hip ratio (WHR) was independently correlated with GLS, GCS, GAS and GRS. FFA was independently correlated with E/e′sr(P＜0.05). The study showed that cardiac structure changed and impaired left ventricular global systolic and diastolic function in overweight and obes population. Moreover, BMI, WHR and FFA may be independent influence factors of cardiac function in overweight and obese population.
Objective To analyze the influence of the body mass index (BMI) and age on deep vein thrombosis (DVT) after the total hip arthroplasty(THA) or total knee arthroplasty(TKA) in Chinese patients who received prophylactic treatment for DVT. Methods We used a randomized clinical case-control study. From April 2004 to August 2004, weperformed THA and TKA for 95 patients (128 hips and knees). There were 27 men and 68 women with an average age of 60 years (range, 23-78) at surgery, and withan average BMI of 25.88 kg/m2 (range, 14.34-40.39) before surgery. All the patients were given low-molecular-weight heparin for 7-10 days pre-and postoperatively to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all the patients before operation and 7-10 days after operation.The patients were divided into 4 groups according to their BMI:the non-obese group (BMI≤25.00 kg/m2), the overweight group (BMI, 25.01-27.00 kg/m2), the obese group (BMI, 27.01-30.00 kg/m2), and the morbidly obese group (BMIgt;30.00 kg/m2); and they were also divided into 4 groups according to their ages (≤40, 4160, 61.70, gt;70 yr) so as to analyze the influence of the BMI and age on DVT. Results The total incidence ofDVT in all the patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. Forty-five patients had DVT and 50 patients had no DVT. The average BMI of the patients with DVT was significantly higher than that of the patients with no DVT (Plt;005). The overweight, obese, and morbidly obese patients had an odds ratio of 7.04, 4.8,and 9.6 for DVT compared with the nonobese patients (P＜0.05); but the obese group had a less risk than the other 2 groups.The 41-60, 61-70, and gt;70-year-old patients had an odds ratio of 24.0, 38.2, and 24.4 for DVT compared with the ≤40year-old patients (P＜0.05). Conclusion Obesity (BMIgt;25 kg/m2) and an increasing age (gt;40 yr) are identified as statistically significant risk factors for DVT after THA or TKA, and patients aged 61-70 years are more likely tohave DVT than the other patients. We should pay more attention to those obesity and aged patients when they are undergoing the total joint replacement, and we should give them enough prophylaxis and closely observe the symptoms in their bilateral lower extremities after operation, taking ultrasonography or venography to check DVT if necessary, so that we can give them prompt treatment and prevent fatal pulmonary thromboembolism.
Objective To investigate the relationship between adipocyte fatty acid binding protein ( A-FABP) and obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 120 patients were recruited and underwent polysomnography. The groups were allocated according severity of OSAHS and obesity. Plasma A-FABP ( ng/mL) levels were measured by ELISA. The associations between A-FABP and AHI, BMI, LSaO2 , MSaO2 , neck collar, waist /hip ratio, insulin resistance index were analyzed. Results Plasma A-FAPB levels were significantly higher in the OSAHS group than in the non-OSAHS group of same weight, independent of age and gender. In the non-OSAHS group and the severe OSAHS group, plasma A-FABP levels of obesity persons were significantly higher than those without obesity, independent of age and gender. Plasma A-FAPB level was positively correlated with AHI, BMI, insulin resistance index, neck collar, SLT90% , and waist/hip ratio, but negatevely correlated with LSaO2 and MSaO2 in the OSAHS group. In the non-OSAHS group, plasma A-FAPB level was positively correlated with BMI and insulin resistance index. Conclusions Plasma A-FABP level is higher in patients with severe OSAHS. Plasma A-FABP level is positively correlated with BMI and insulin resistance index both in OSAHS and non-OSAHS patients.
Objective To evaluate the relationship between body mass index (BMI) and malignant lymphoma by means of Meta-analysis. Methods Such databases as Web of Science, PubMed, EBbase, CNKI, Wanfang, VIP and CBM were searched from the date of their establishment to April 2011 to collect the case control studies on the relationship between BMI and malignant lymphoma. Two researchers independently selected studies, extracted data and assessed the quality according to the inclusive and exclusive criteria, and then conducted Meta-analyses by using RevMan5.0 software for heterogeneity test and pooled OR calculation. Results Seven case control studies involving 8416 malignant lymphoma patients and 14760 other patients were included. The quality of all studies scored 4, indicating reliable quality. Meta-analyses of the low BMI, overweight and obesity population were OR=0.8, 95%CI 0.79 to 0.95, P=0.003; OR=1.04, 95%CI 0.98 to 1.11, P=0.16; and OR=1.22 95%CI 1.04 to 1.43, P=0.01, respectively. The stratified Meta-analysis on histological subtypes showed that obesity was associated with a significantly increased risk of diffuse large B cell lymphoma (OR=1.33 95%CI 1.18 to 1.50, Plt;0.000 01), but was not associated with the follicular lymphoma or small lymphocytic lymphoma/chronic lymphocytic leukemia. Conclusion These findings demonstrate that low BMI is associated with the decrease of malignant lymphoma, and obesity is an increasing risk of malignant lymphoma, especially, the diffuse large B cell lymphoma.
ObjectiveTo analyze impact of body mass index (BMI) on postoperative complications and disease-free survival (DFS) after hepatectomy for patients with hepatocellular carcinoma (HCC). MethodsIn total, 858 patients with HCC underwent hepatectomy were analyzed by retrospective cohort study. Patients were divided into two groups according to BMI:normal group (18.5 kg/m2 < BMI < 25.0 kg/m2) and obesity group (BMI≥25.0 kg/m2). The clinical and postoperative follow-up data were collected and statistically analyzed. Results① Compared with the normal group, the preoperative HBV-DNA loading was significantly lower (P<0.05), albumin was significantly higher (P<0.05), intraopera-tive blood loss was significantly increased (P<0.05), operation time, and the first portal hepatis occlusion time were signifi-cantly prolonged (P<0.05) in the obesity group. The postoperative complications and hospital stay had no significant differences between these two groups (P>0.05). ② The results of univariate analysis showed that the preoperative HBV-DNA≥ 104 U/mL, total bilirubin >21 μmol/L, albumin <35 g/L, grade B of Child-Pugh, intraoperative blood loss >500 mL, and operation time >240 min were associated with the postoperative complications after hepatectomy for patients with HCC (P<0.05). The results of multivariate analysis showed that preoperative total bilirubin >21 μmol/L, albumin <35 g/L, and operation time >240 min were the independent risk factors for postoperative complications (P<0.05). ③ Kaplan-Meier analysis showed that the 3-year DFS in the obesity group was significantly better than that in the normal group (P<0.05). The results of multivariate analysis showed that the major blood vessel tumor thrombi, multicenter tumor, tumor diameter ≥5 cm, and operation time >240 min were the independent risk factors for DFS (P<0.05), while the obesity was the protective factor for DFS (P<0.05). ConclusionFor HCC patients who receiving hepatectomy, obesity does not increase risk of postoperative complications, and could increase 3-year DFS. Thus preoperative improvement of nutritional status of patient with HCC has a great significance.