慢阻肺缓解期患者营养不良及其相关因素分析

A research on malnutrition pathogenesis in patients with stable chronic obstructive pulmonary disease

观察７６例慢阻肺（ＣＯＰＤ）缓解期患者的肺功能、饮食摄入情况与营养状况的关系，并探讨ＣＯＰＤ患者营养不良发生的机理。结果显示５４０％的ＣＯＰＤ患者体重低于理想体重的９０％。８４２％的患者膳食中热能摄入量低于正常人标准供给量（ＲＤＡ）。ＦＥＶ１占预计值百分比（％ＦＥＶ１），ＦＥＶ１／ＦＶＣ％与饮食中总热能摄入量占正常人标准供给量的百分比（Ｅ％ＲＤＡ）呈正相关（ｒ分别为０２７０和０３７３，Ｐ＜００５），ＦＶＣ占预计值百分比（％ＦＶＣ）与Ｅ％ＲＤＡ相关无显著性。Ｅ％ＲＤＡ与体重占理想体重百分比（％ＩＢＷ），体重身高指数（ＢＭＩ）和血清白蛋白（Ａｌｂ）量均呈正相关（ｒ分别为０３１１，０３７１和０３３９，Ｐ＜００５），而与三头肌皮褶厚度或上臂肌围相关无显著性。％ＦＥＶ１、ＦＥＶ１／ＦＶＣ％分别与％ＩＢＷ、ＢＭＩ相关（ｒ分别为０２３８，０２７３，０３６４，０３７５，Ｐ＜００５），与其它营养指标相关无显著性。％ＦＶＣ与各营养指标相关均无显著性。结论：ＣＯＰＤ患者随气道阻塞加重，饮食中热能摄入量反而减少，使饮食摄入与热能消耗严重失衡，是ＣＯＰＤ患者合并营养不良的主要原因之一。

patients with stable COPD were observed in their lung function, food intake and nutritive status, in order to study pathogenesis of malnutrition The results showed that 54 0% of patients had their body weight less than 90% of ideal body weight(%IBW) In 84 2% of patients, daily intake of energy was insufficient according to recommended daily amount(RDA) The significant correlation were present between FVC%pred,FEV 1/FVC and E%RDA (daily energy intake expressed as percent of RDA, r =0 270, 0 373 respectively, P <0 05),between E%RDA and %IBW, BMI(body mass index), albumin ( r =0 311,0 371,0 339 respectively P <0 05), between FEV 1%pred, FEV 1/FVC and %IBW,BMI( r =0 238, 0 273, 0 364, 0 375 respectively P <0 05) No significant correlation was found between FVC%pred and food intake, between E%RDA and triceps skinfold thickness (TSF),mid arm muscle circumference(MAMC),between FVC%pred and nutrition parameters Conclusion: Insufficiency of food intake is one of the important reasons of malnutrition complicated with stable COPD Nutrition intervention, especialy oral supplement for these patients helps to prevent and treat malnutrition