稳定期COPD患者骨骼肌力量下降现状及膳食风险因素分析

Status of skeletal muscle strength decline and analysis of dietary risk factors in patients with stable chronic obstructive pulmonary disease

目的了解慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者骨骼肌力量下降现状,分析膳食影响因素并建立风险诊断模型。方法以来自乌鲁木齐市两社区的370例稳定期COPD患者为研究对象,对患者进行膳食调查、握力测量、体成分分析及实验室检查,描述及分析不同特征患者骨骼肌力量下降现状。在此基础上采用Lasso-logistic回归筛选变量并建立风险模型,计算诊断模型的受试者工作特征区线(ROC)下面积(AUC)进行验证。结果所调查370例COPD患者骨骼肌力量下降的检出率为38.7%。根据Lasso-logistic回归分析得到食物种类不足(OR=2.27,95%CI 1.79~3.35),高龄(OR=1.09,95%CI 1.04~1.16),相对于COPDⅠ级,COPDⅡ级(OR=1.85,95%CI 1.52~2.23)、Ⅲ级(OR=2.69,95%CI 1.29~3.39)、Ⅳ级(OR=3.06,95%CI 1.63~5.85)均是骨骼肌力量降低的危险因素,而更高的去脂体质量指数(fat free mass index,FFMI)是骨骼肌力量下降的保护因素(OR=0.88,95%CI 0.80~0.97),模型验证AUC为0.958。结论膳食种类、FFMI、病情严重程度均与骨骼肌力量下降密切相关,应采取精准评估,有效预防及延缓肌肉力量下降,提高患者健康水平。

Objective To understand the status of skeletal muscle strength decline in patients with chronic obstructive pulmonary disease(COPD),analyze the influencing factors of diet and develop a risk diagnosis model.Methods A total of 370 COPD patients from two communities in Urumqi were enrolled,and dietary surveys,grip strength measurements,body composition analysis and laboratory tests were performed to describe and analyze the current status of skeletal muscle strength decline in patients with different characteristics.On this basis,Lasso-logistic regression was used to screen the variables and establish a risk model,and the area under the receiver operating characteristic curve(AUC)of the diagnostic model was calculated for validation.Results Detection rate of decreased skeletal muscle strength in COPD patients was 38.7%.According to the variables screened by Lasso-logistic regression analysis,diet variety(OR=2.27,95%CI 1.79-3.35),old age(OR=1.09,95%CI 1.04-1.16),relative to COPD grade I,COPD gradeⅡ(OR=1.85,95%CI 1.52-2.23),COPD gradeⅢ(OR=2.69,95%CI 1.29-3.39),COPD gradeⅣ(OR=3.06,95%CI 1.63-5.85)were associated with high risk of skeletal muscle strength decline,and the high FFMI was a protective factor for skeletal muscle strength decline(OR=0.88,95%CI 0.80-0.97).The area under the receiver operating characteristic curve(AUC)was 0.958.Conclusion The type of diet,FFMI and the severity of illness are closely related to the decrease of skeletal muscle strength,and accurate evaluation and comprehensive intervention should be taken to effectively prevent and delay the decline of muscle strength and improve the health level of patients.