慢性阻塞性肺疾病稳定期患者营养不良对肺功能的影响及其机制研究

Impact of Malnutrition on Pulmonary Function in Patients with Stable Chronic Obstructive Pulmonary Disease and Its Mechanism

目的探究慢性阻塞性肺疾病(COPD)稳定期患者营养不良对肺功能的影响及其机制。方法选取2015年2月—2018年4月四川攀枝花攀钢集团总医院密地院区呼吸内科收治的183例COPD稳定期患者作为观察组,另选取同期在四川攀枝花攀钢集团总医院密地院区体检中心进行体检的健康者150例作为对照组;根据微型营养评定(MNA)评分将COPD患者分为营养良好亚组(MNA评分≥24分)和营养不良亚组(MNA评分<24分)。比较两组受试者肺功能指标〔包括第1秒用力呼气容积(FEV1)占预计值百分比和FEV1/用力肺活量(FVC)〕、营养状况及氧化应激指标〔包括血清蛋白质羰基(PC)、8-羟基脱氧鸟苷(8-OHdG)、丙二醛及总抗氧化能力(TAC)水平〕,营养良好亚组与营养不良亚组患者氧化应激指标;COPD稳定期患者MNA评分相关因素分析采用多元线性回归分析。结果观察组患者FEV1占预计值百分比、FEV1/FVC及血清TAC水平低于对照组,营养状况劣于对照组,血清PC、8-OHdG、丙二醛水平均高于对照组(P<0.05)。营养良好亚组患者FEV1占预计值百分比、FEV1/FVC高于营养不良亚组,血清PC、TAC水平低于营养不良亚组(P<0.05)。多元线性回归分析结果显示,FEV1占预计值百分比、FEV1/FVC与COPD稳定期患者MNA评分呈正相关,血清PC、TAC水平与COPD稳定期患者MNA评分呈负相关(P<0.05)。结论COPD稳定期患者发生营养不良可导致机体蛋白质羰基化、加重气流受限,进而影响患者肺功能,因此临床应积极纠正COPD稳定期患者营养。

Objective To investigate the impact of malnutrition on pulmonary function in patients with stable chronic obstructive pulmonary disease(COPD)and its mechanism.Methods From February 2015 to April 2018,a total of 183 patients with stable COPD who admitted to the Department of Respiratory Medicine,Midi Hospital,General Hospital of Pangang Group were selected as the observation group,and 150 healthy people who underwent physical exa mination were selected as the control group during the same period.COPD patients were divided into good nutrition subgroup(MNA score≥24)and malnutrition subgroup(MNA score<24)according to the MNA score.The lung function indexes(including FEV1%and FEV1/FVC),nutritional status and oxidative stress indexes(including serum levels of PC,8-OHdG,MDA and TAC)were compared between the two groups,the oxidative stress indexes were compared between the good nutrition subgroup and malnutrition subgroup.Multivariate linear regression analysis was used to analyze the related factors of MNA score in stable COPD patients.Results The FEV1%,FEV1/FVC and serum TAC level in the observation group were lower than those in the control group,and the nutritional status in the observation group was worse than that in the control group,the serum levels of PC,8-OHdG and malondialdehyde in the observation group were higher than those in the control group(P<0.05).The FEV1%,FEV1/FVC in good nutrition subgroup were higher than those in malnutrition subgroup,while serum levels of PC and TAC were lower than those in malnutrition subgroup(P<0.05).Multiple linear regression analysis showed that,FEV1%and FEV1/FVC were positively correlated with MNA score in stable COPD patients,while serum levels of PC and TAC were negatively correlated with MNA score in stable COPD patients(P<0.05).Conclusion Malnutrition in stable COPD patients can lead to protein carbonylation,increased airflow limitation,which has a serious impact on the pulmonary function,so patients should pay more attention on their nutritional status.