稳定期慢性阻塞性肺疾病患者的去脂质量指数与骨强度的关系

The association between body composition and bone stiffness in patients with stable chronic obstructive pulmonary disease

目的 探讨稳定期慢性阻塞性肺疾病（慢阻肺）患者的去脂质量指数与骨强度关系.方法 纳入2013年3月至2014年1月的稳定期慢阻肺患者94例及健康吸烟者47名,所有受试者均为男性,其中慢阻肺组年龄45～79岁,平均（65±7）岁,对照组年龄40～79岁,平均（58±9）岁.测定肺功能、机体构成及骨强度,采用慢阻肺评估测试中文版问卷、mMRC量表评价慢阻肺患者症状、记录其最近12个月急性加重次数及因此住院次数并进行比较.正态分布数据用均数±标准差、非正态分布数据用中位数（四分位数间距）表示.符合正态分布的数据,若方差齐,采用t检验进行两组间比较;若方差不齐,则采用t’检验进行两组间比较.结果 稳定期慢阻肺组患者合并肌肉萎缩[去脂质量指数（FFMI）＜ 16 kg/m^2]和骨折高风险[骨强度指数（SI）T＜-1]的发生率分别为24.5％ （23/94）和72.3％（68/94）.合并肌肉萎缩的慢阻肺患者与肌肉体积正常的患者相比,FEV1占预计值％降低[（39±15）％,（50±16）％]、最近12个月急性加重次数增加[1.0（0～3.0）,0（0～1.0）]、骨强度指数降低[（76±13）％,（86±16）％,t值和t’值分别为2.904,-1.476,2.728,均P＜0.05],存在骨折高风险的慢阻肺患者与骨折低风险的患者相比,mMRC评分增加[2.0（1.0 ～3.0）和1.0（0～2.0）]（Z值为-2.297,P＜0.05）.慢阻肺患者去脂指数与骨强度指数呈正相关（r=0.294,P＜0.05）.结论 合并肌肉萎缩和骨折高风险的稳定期男性慢阻肺患者肺功能降低,未来急性加重风险增加,二者呈正相关,慢阻肺患者应注意筛查上述合并症.

Objective To determine the body composition and bone stiffness in patients with stable chronic obstructive pulmonary disease （COPD）,and to explore the association between them.Methods Ninety-four male COPD patients in stable conditions and 47 healthy smokers were recruited from March 2013 to January 2014.Lung function,body composition and bone stiffness were measured.In COPD patients,the symptoms were assessed by COPD Assessment Test （CAT） and Modified British Medical Research Council （mMRC） respectively,and the acute exacerbation and hospitalization history in the previous 12 months were also recorded.Results The prevalence of muscle atrophy （FFMI ＜ 16 kg/m2） and high risk of bone fracture（T ＜-1） were 24.5％ and 72.3％ respectively in stable male COPD patients.The patients with muscle atrophy,had lower FEV1％ pred （39.0 ± 15.2） vs （50.1 ± 16.2）,frequent acute exacerbations [1.0（0-3.0） vs 0（0-1.0）] and lower bone stiffness index（75.5 ± 13.3） vs （85.5 ± 15.7）,（test values were 2.904,-1.476,2.728,all P ＜ 0.05）.Compared with patients with low risk of bone fracture （T ≥-1）,patients with high risk of bone fracture （T ＜-1） showed higher mMRC score [2.0 （1.0-3.0） vs 1.0（0-2.0）] （Z =-2.297,P ＜ 0.05）.The FFMI correlated positively with SI （r =0.294,P =0.004） in COPD patients.Conclusions Patients with stable COPD presented worse lung function and increased risk of future exacerbations when combined with muscle atrophy and high risk of bone fracture,and the two co-morbidities were correlated and should be assessed.