慢性阻塞性肺疾病严重程度与骨骼肌营养不良的相关性研究

Correlation between Severity of Chronic Obstructive Pulmonary Disease and Skeletal Muscle Malnutrition

背景慢性阻塞性肺疾病(COPD)是全球主要致死性慢性病之一,不断加重全球经济负担。骨骼肌营养不良作为COPD常见并发症之一,严重影响了患者的生活质量及预后,但目前关于其发生机制、预防和治疗的研究尚不完善。目的探讨COPD严重程度与骨骼肌营养不良的相关性。方法以2017年9月—2019年6月就诊于锦州医科大学附属第一医院的COPD患者205例作为病例组,另选取同一时期于该院行体检的性别、年龄与病例组相匹配的健康成年人125例为对照组,检测两组各项身体成分指标、舒张气管后肺功能。采用单因素分析比较两组同性别受试者的各项身体成分指标,采用Pearson相关分析和Spearman秩相关探讨COPD患者第1秒用力呼气末容积占预计值百分比(FEV1%)、深吸气量与肺总量比值(IC/TLC)与各项身体成分指标的相关性。结果男性COPD患者BMI、去脂体质量(FFM)、全身肌肉量、躯干肌肉量、双上肢肌肉量、双下肢肌肉量、四肢肌肉量、握力、骨骼肌指数、去脂体质数低于对照组男性(P<0.05),女性COPD患者BMI、FFM、全身肌肉量、躯干肌肉量、双上肢肌肉量、双下肢肌肉量、四肢肌肉量、握力、骨骼肌指数、去脂体质数低于对照组女性(P<0.05)。相关分析结果显示,男性COPD患者IC/TLC与FFM、全身肌肉量、躯干肌肉量、双上肢肌肉量、双下肢肌肉量、四肢肌肉量、握力、骨骼肌指数、去脂体质数呈正相关(P<0.05),女性COPD患者IC/TLC与BMI、FFM、全身脂肪量、全身肌肉量、躯干肌肉量、双上肢肌肉量、双下肢肌肉量、四肢肌肉量、握力、骨骼肌指数、去脂体质数、脂肪体质数呈正相关(P<0.05)。除男性COPD患者FEV1%与握力呈线性正相关外(P<0.05),FEV1%与男性、女性COPD患者其他身体成分指标无相关关系(P>0.05)。结论COPD患者BMI、FFM、肌肉量及握力低于健康者;COPD患者身体成分指标与FEV1%不相关,与反应疾病严重程度的另一项指标IC/TLC存在明显相关性。

Background Chronic obstructive pulmonary disease(COPD)is one of the world's leading lethal chronic diseases,which continues to the increase of global economic burden.Skeletal muscle malnutrition,as one of the common complications of COPD,seriously affects patient's quality of life and prognosis,but the research on its mechanism,prevention and treatment is currently incomplete.Objective To explore the correlation between the severity of COPD and skeletal muscle malnutrition.Methods From September in 2017 to June in 2019,205 COPD patients who treated in the First Affiliated Hospital of Jinzhou Medical University were selected as the case group,and 125 healthy people who underwent physical examination at the same period were selected as the control group(gender and age matched to case group).Various body composition indexes and pulmonary function after diastole were measured in two groups.Univariate analysis was used to compare the body composition indexes of two groups.Pearson correlation analysis and Spearman's rank correlation were used to explore the correlation between percentage of forced expiratory volume in 1 second(FEV1%)predicted,inspiratory capacity and total lung capacity ratio(IC/TLC),and various body composition indexes.Results The BMI,fat-free mass(FFM),total muscle mass,trunk muscle mass,double upper limb muscle mass,double lower limb muscle mass,limb muscle mass,grip strength,skeletal muscle index,and fat-free BMI of male patients with COPD were lower than those of male patients in control group(P<0.05).Female patients with COPD had lower BMI,FFM,total muscle mass,trunk muscle mass,double upper limb muscle mass,double lower limb muscle mass,limb muscle mass,grip strength,skeletal muscle index,and fat-free BMI than females in the control group(P<0.05).The correlation analysis showed that IC/TLC had positive correlation with FFM,total muscle mass,trunk muscle mass,double upper limb muscle mass,double lower limb muscle mass,limb muscle mass,grip strength,skeletal muscle index,and fat-free BMI in male COPD patients(P<0.05),and IC/TLC had positive correlation with BMI,FFM,total fat mass,total muscle mass,trunk muscle mass,double upper limb muscle mass,double lower limb muscle mass,limb muscle mass,grip strength,skeletal muscle index,fat-free BMI,and fat BMI in female COPD patients(P<0.05).Except that FEV1%in male COPD patients had a linear positive correlation with grip strength(P<0.05),FEV1%had no correlation with other body composition indexes in male and female COPD patients(P>0.05).Conclusion BMI,FFM,muscle mass,and grip strength of COPD patients are lower than those of healthy people.Body composition indexes of COPD patients are not related to FEV1%,but have significant correlation with IC/TLC,another index that reflects the severity of the disease.