体质指数对AECOPD患者气道黏液高分泌及生活质量的影响

Effect of body mass index on airway mucus hypersecretion and quality of life in AECOPD patients

目的探讨不同体质指数(BMI)慢性阻塞性肺疾病急性加重(AECOPD)患者治疗前后气道黏液高分泌及生活质量否有差异。方法将既往肺功能GOLD分级为Ⅲ~Ⅳ级131例AECOPD住院患者按BMI进行分组:BMI<18.5kg/m^2为A组29例,BMI18.5kg/m^2~23.9kg/m^2为B组61例,BMI≥24.0kg/m^2为C组41例。患者均在常规治疗的基础上予醋酸泼尼松片30mgqd连续治疗7天。于入院后第1d及第8d记录患者CAT评分、同时用酶联免疫吸附法测定痰液中黏蛋白MUC5ac和中性粒细胞弹性蛋白酶(NE)含量,并于治疗后第8天测定6MWD、肺功能和气道阻力。结果治疗后各组的CAT评分、MUC5ac和NE均较入院时明显好转(P<0.01或P<0.05)。与C组和B组相比,A组患者的CAT评分最高,MUC5ac及NE最低(P<0.01或P<0.05);C组的CAT评分、MUC5ac和NE均高于B组(P<0.01或P<0.05)。A组患者治疗前后CAT评分、MUC5ac和NE的变化差值最小(P<0.01或P<0.05)、B组的CAT评分以及C组的MUC5ac和NE变化差值最大(P<0.01)。治疗后B组及C组的6MWD高于A组(P<0.05)。随着BMI的增加,A、B、C三组的FEV1增加而RV/TLC减少(P<0.01或P<0.05);A组的FEV1%pred低于C组、A组的FEV1/FVC均低于B组和C组(P<0.01或P<0.05)。BMI与入院时MUC5a、治疗前后的NE、FEV1%pre和FEV1/FVC呈正相关性(P<0.01或P<0.05);与RV/TLC呈负相关(P<0.01)。结论高BMI的AECOPD患者的气道黏液高分泌更明显,低BMI慢阻肺患者在急性期治疗的临床效果及生活质量相对较差。BMI与MUC5ac、NE、FEV1%pre和FEV1/FVC呈正相关性,与RV/TLC呈负相关。

Objective To explore whether there are differences in airway mucus hypersecretion and quality of life before and after treatment in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with different body mass index (BMI).Methods 131 cases of AECOPD patients with previous pulmonary function GOLD grade Ⅲ to Ⅳ were grouped according to BMI:BMI<18.5kg/m^2 as the group A (29 cases) BMI 18.5 kg/m^2~23.9kg/m^2 as the group B (61 cases),and BMI ≥24.0kg/m^2 as the group C (41 cases).All patients were treated with prednisone acetate tablets 30mg QD for 7 consecutive days on the basis of routine treatment.Chronic obstructive pulmonary assessment test (CAT) score was recorded,sputum mucin MUC5ac and neutrophil elastase (NE) content were detected by enzyme linked immune-sorbent assay at first day and 8th day after admission.6-minute walk distance (6MWD),pulmonary ventilation function and airway resistance were measured 8 days after treatment. Results After treatment,the CAT scores,MUC5ac and NE were significantly better than those at admission ( P< 0.01 or P< 0.05).The CAT score in the group A was the highest,MUC5ac and NE were the lowest compared with the group C and the group B ( P< 0.01 or P< 0.05).The CAT score,MUC5ac and NE in the group C were higher than those in the group B ( P< 0.01 or P< 0.05).The change difference of CAT score,MUC5ac and NE in the group A before and after treatment were the smallest ( P< 0.01 or P< 0.05).The change difference of CAT score in the group B and MUC5ac and NE in the group C was the largest ( P< 0.01 or P< 0.05).The 6MWD of the group B and the group C was higher than that of the group A ( P< 0.05).The first second forced breathing volume (FEV 1) was increased,while the residual volume/total lung capacity (RV/TLC) was decreased with the increase of BMI in the three groups ( P< 0.01 or P< 0.05).The percent of first second forced expiratory volume compared its predicted value (FEV 1%pred) in the group A was lower than that in the group C,and the first second forced expiratory volume/forced vital capacity (FEV 1/FVC) in the group A was lower than those of the group B and C ( P< 0.01 or P< 0.05).BMI was positively correlated with MUC5a at admission,NE before and after treatment,FEV 1pre% and FEV 1/FVC ( P< 0.01 or P< 0.05),and negatively correlated with RV/TLC ( P< 0.01). Conclusion The airway mucus hypersecretion of patients with high BMI is the most obvious,while the clinical effect and quality of life of patients with low BMI COPD in acute stage are relatively poor.There are positive correlations of BMI with MUC5a,NE,FEV 1%pre and FEV 1/FVC,and negative correlation with RV/TLC.