ERJ：肥胖可能降低肺炎住院患者的死亡率

在美国，肥胖已经成为一个日益严重的问题，但对肥胖和肺炎之间关系的研究却得到了相互矛盾的结果。来自得克萨斯大学健康科学中心的Phoebe King等人对肥胖和肺炎之间关系进行了研究，结果于2013年4月1日发表在European Respiratory Journal。研究人员病态肥胖并不与死亡率相关，相反肥胖与死亡率下降相关。由此研究人员得出结论，肥胖可降低肺炎住院患者的死亡率。

研究人员采用退伍军人事务部2002 - 2006年财政年度的管理数据，对出院诊断为肺炎的住院患者队列进行了检查。 身体质量指数被分类为体重过轻（<18.5 kg·m?2）、正常（18.5-24.9 kg·m?2，参考组）、超重（25-29.9 kg·m?2）、肥胖（30-39.9 kg·m?2）和病态肥胖（≥40 kg·m?2）。 我们的主要采用多层次回归模型对90天死亡率、重症监护病房（ICU）入住率、机械通气和升压药使用情况进行分析。

此队列包含18 746位受试者： 其中体重过轻者占3％、体重正常者占30％、超重者占36%、肥胖者占27%、病态肥胖者占4%。 在回归模型中，对潜在混杂因素进行调整后，结果发现病态肥胖并不与死亡率相关（OR=0.96，95％CI为0.72-1.28），相反肥胖与死亡率下降相关（OR=0.86，95％CI为0.74-0.99）。 无论是肥胖或病态肥胖均与入住ICU、使用机械通气或升压药相关。 体重过轻患者的90天死亡率则增加（OR=1.40，95％CI为1.14-1.73）。

研究人员由此认为，虽然肥胖的流行病学情况日益严重，但其对临床结果的影响不大，并可能降低退伍军人因肺炎住院的死亡率。

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Impact of obesity on outcomes for patients hospitalised with pneumonia
Abstract
Obesity is an increasing problem in the USA, and research into the association between obesity and pneumonia has yielded conflicting results. Using Department of Veterans Affairs administrative data from fiscal years 2002-2006, we examined a cohort of patients hospitalised with a discharge diagnosis of pneumonia. Body mass index was categorised as underweight (<18.5 kg·m(-2)), normal (18.5-24.9 kg·m(-2), reference group), overweight (25-29.9 kg·m(-2)), obese (30-39.9 kg·m(-2)) and morbidly obese (≥40 kg·m(-2)). Our primary analyses were multi level regression models with the outcomes of 90-day mortality, intensive care unit (ICU) admission, need for mechanical ventilation and vasopressor utilisation. The cohort comprised 18 746 subjects: 3% were underweight, 30% were normal, 36% were overweight, 27% were obese and 4% were morbidly obese. In the regression models, after adjusting for potential confounders, morbid obesity was not associated with mortality (OR 0.96, 95% CI 0.72-1.28), but obesity was associated with decreased mortality (OR 0.86, 95% CI 0.74-0.99). Neither obesity nor morbid obesity was associated with ICU admission, use of mechanical ventilation or vasopressor utilisation. Underweight patients had increased 90-day mortality (OR 1.40, 95% CI 1.14-1.73). Although obesity is a growing health epidemic, it appears to have little impact on clinical outcomes and may reduce mortality for veterans hospitalised with pneumonia.