慢性阻塞性肺疾病急性加重患者低密度脂蛋白胆固醇降低与静态肺过度充气相关

Low-density lipoprotein cholesterol is associated with inspiratory capacity to total lung capacity ratio in acute exacerbations of chronic obstructive pulmonary disease patients

目的探讨慢性阻塞性肺疾病急性加重（acute exacerbations of chronic obstructive pulmonary disease，AECOPD）患者静态肺过度充气与营养状态的相互关系。方法收集2010年7月至2011年7月在首都医科大学附属北京朝阳医院呼吸科住院诊治的AECOPD患者108例，其中男75例，女33例，年龄48～89岁，中位数72岁。住院期间对所有患者进行肺功能和多项营养参数检测，并根据吸气分数（inspiratory capacity／total lung capacity，IC／TLC）将其分为静态肺过度充气组（IC／TLC〈0．25）和非静态肺过度充气组（IC／TLC≥O．25），对两组间结果进行比较。结果与无静态肺过度充气的患者相比，存在静态肺过度充气的AECOPD患者具有更高的吸烟指数（20．5包·年VS30包·年，P=0．048）、更严重的气流阻塞程度[FEV1％pred，（58．4±23．1）％vs（36．4±14．1）％，P〈O．001]和更低的氧气弥散能力[D_LCO／VA％pred，（65．4±28．3）％VS（44．1±27．7）％，P〈0．001]。存在静态肺过度充气的AECOPD患者血清低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDLc）的水平低于无静态肺过度充气者[（2．36±0．71）mmol／LVS（2．66±0．74）mmol／L，P=0．042]。IC／TLC的比值与患者血清LDLc的水平呈正相关（r=0．29，P=0．002），且IC／TLC比值每降低1％，LDLc水平就随之降低约0．02mmol／L。两组患者在血清白蛋白、前白蛋白、总胆固醇、高密度脂蛋白胆固醇、甘油三酯、血肌酐、肌酸激酶水平上的差异均无统计学意义。结论AECOPD患者的血清LDLc水平降低与静态肺过度充气程度相关，推测LDLc可能是早期筛查AECOPD患者营养不良的一个敏感指标。

Objective Air trapping leads to a reduction in inspiratory capacity / total lung capacity （IC/TLC） ratio in patients with chronic obstructive pulmonary disease（COPD）. Knowledge of the effects of low IC/TLC ratio （IC/TLC d0. 25） on nutritional status and respiratory impairment during acute exacerbations of COPD （AECOPD） is limited. Methods In 108 patients admitted to the hospital due to an AECOPD （75 men; median age, 72 years [interquartile range （IQR）, 65 to 76 years] ; FEV1% pred, （44. 5±20.8）%）, we measured pulmonary function （body plethysmograph）, BMI and nutritional parameters, including serum albumin, prealbumin, cholesterol, triglycerides, high-density lipoprotein cholesterol （HDLc）, low-density lipoprotein cholesterol （LDLc）, creatinine and creatine kinase （CK）. Results Patients with low IC/TLC ratio （〈0.25） had significantly greater pack years of smoking, and lower FEV1, FEV1/FVC, and D_LCO/VA. Lower serum LDLc levels were seen in group with low IC/ TLC ratio compared to those patients with IC/TLC≥0.25 [（2.36±0.71 ） mmol/L vs （2.66 ± 0.74） mmol/L, P =0. 042]. The decrease in IC/TLC ratio correlated positively with serum LDLc levels （ r = 0.29, P =0. 002）, and with the reduction of IC/TLC by every 1%, the change in LDLc was 0.02 mmol/ L. No differences were observed in serum albumin, prealbumin, cholesterol, triglyeerides, HDLc, creatinine and CK between both groups. Conclusions In patients with AECOPD, low IC/TLC is associated with lower serum LDLc levels, suggesting LDLc may be a promising marker for the detection of early malnutrition.