Page 83 - 南京医科大学自然版

第46卷第4期 南京医科大学学报（自然科学版）
2026年4月 Journal of Nanjing Medical University（Natural Sciences） ·551 ·

·临床研究·

肥胖减弱心力衰竭患者标准药物治疗后的心脏逆重构

李皓阳 ，钱芷君 ，曾嘉欣 ，张恩瑞 ，王 垚 ，钱智勇 ，侯小锋 ，朱晓梅 ，邹建刚 1*
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南京医科大学第一附属医院心血管内科，放射科，江苏 南京 210029
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［摘 要］ 目的：探讨肥胖对接受指南指导的药物治疗（guideline⁃directed medical therapy，GDMT）的射血分数降低和轻度降低
的心力衰竭（heart failure with reduced and mildly reduced ejection fraction，HFrEF/HFmrEF）患者心脏逆重构的影响。方法：回顾
性分析 2022 年 1 月—2024 年 10 月在南京医科大学第一附属医院就诊且左心室射血分数（left ventricular ejection fraction，
LVEF）<50%的心衰患者。所有患者均接受GDMT 治疗，并于基线时接受心脏磁共振检查（cardiac magnetic resonance，CMR），
通过延迟钆增强（late gadolinium enhancement，LGE）和细胞外容积分数（extracellular volume fraction，ECV）评估心肌纤维化。肥
胖定义为体重指数（body mass index，BMI）≥28 kg/m 。在基线和GDMT治疗6个月后采用超声心动图评估心脏逆重构，治疗有
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反应定义为LVEF绝对增加≥5%。结果：共纳入80例患者（肥胖组31例，非肥胖组49例）。与非肥胖组相比，肥胖组LVEF改
善幅度及治疗反应率均较低［ΔLVEF：（14.45±2.08）% vs.（20.80±1.81）%，P=0.024；反应率：76.80% vs. 93.58%，P=0.036］。多因
素回归分析显示 BMI 是 LVEF 改善的独立负向预测因素（β=-0.90，P=0.004）。LGE（OR=0.68，P=0.025）和 ECV（OR=0.89，
P=0.012）均为治疗应答降低的独立预测因素。整合BMI与ECV的预测模型对低反应者的识别能力最佳，曲线下面积为0.923，
且显著优于基线模型（P=0.043）。结论：在HFrEF/HFmrEF患者中，肥胖与GDMT治疗后心脏逆重构减弱及治疗反应性降低相
关，联合BMI与ECV有助于识别治疗反应降低的高风险患者。
［关键词］ 肥胖；心力衰竭；心脏逆重构；指南指导的药物治疗；心肌纤维化；心脏磁共振
［中图分类号］ R541.6 ［文献标志码］ A ［文章编号］ 1007⁃4368（2026）04⁃551⁃10
doi：10.7655/NYDXBNSN260036

Obesity attenuates cardiac reverse remodeling following guideline ⁃ directed medical
therapy in patients with heart failure
LI Haoyang ，QIAN Zhijun ，ZENG Jiaxin ，ZHANG Enrui ，WANG Yao ，QIAN Zhiyong ，HOU Xiaofeng ，
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ZHU Xiaomei ，ZOU Jiangang 1*
1 Department of Cardiology，Department of Radiology，the First Affiliated Hospital of Nanjing Medical University，
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［Abstract］ Objective：To investigate the impact of obesity on cardiac reverse remodeling in patients with heart failure with reduced
or mildly reduced ejection fraction（HFrEF/HFmrEF）receiving guideline⁃directed medical therapy（GDMT）. Methods：A retrospective
analysis was conducted on heart failure patients with a left ventricular ejection fraction（LVEF）<50% treated at the First Affiliated
Hospital of Nanjing Medical University between January 2022 and October 2024. All patients received GDMT and underwent baseline
cardiac magnetic resonance（CMR）imaging at baseline. Myocardial fibrosis was assessed via late gadolinium enhancement（LGE）and
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extracellular volume fraction（ECV）. Obesity was defined as a body mass index（BMI）≥28 kg/m . Cardiac reverse remodeling was
evaluated by echocardiography at baseline and after 6 months of GDMT. Treatment response was defined as an absolute increase in
LVEF ≥5%. Results：A total of 80 patients were included（31 in the obese group and 49 in the non⁃obese group）. Compared to the non⁃
obese group，the obese group showed a smaller improvement in LVEF and a lower treatment response rate［ΔLVEF：（14.45 ± 2.08）%
vs.（20.80 ± 1.81）%，P=0.024；response rate：76.80% vs. 93.58%，P=0.036］. Multivariable regression analysis confirmed that BMI was
an independent negative predictor of LVEF improvement（β=-0.90，P=0.004）. Both LGE（OR=0.68，P=0.025）and ECV（OR=0.89，P=
0.012）were independent predictors of reduced treatment response. A predictive model combining BMI and ECV demonstrated the

［基金项目］ 江苏省医学新技术专项（JX233C202103）
通信作者（Corresponding author），E⁃mail：jgzou@njmu.edu.cn（ORCID：0000⁃0001⁃5891⁃6589）
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