慢性阻塞性肺疾病患者的肌肉量水平对病情进展的影响

Progress of chronic obstructive pulmonary disease patients with different muscle mass levels

目的探讨不同肌肉量水平的慢性阻塞性肺疾病患者病情进展的差异,并研究相关因素对患者病情发展的影响。方法选取在河北省衡水市人民医院就诊的慢性阻塞性肺疾病患者308例纳入分析,患者全部为中度以下的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者。入组测定患者肌肉量水平并据此分组,肌少症组(98例)和对照组(210例)。全部受试对象均随访4个月,观察患者病情进展;讨论肌肉量水平与肺功能水平以及6 MIN步行试验距离(6 MINUTE WALK DISTANCE,6MWD)结果和慢性阻塞性肺疾病评估测试(COPD assessment test,CAT)评分结果等之间的关联,分析对患者病情进展的影响;同时讨论相关因素(体脂率,维生素D水平等)对不同肌肉量水平患者病情的潜在影响。结果同等治疗干预下,肌少症组患者肺功能水平基线与随访对比改善水平均低于对照组(P<0.05);同时肌少症组患者基线与随访的6MWD测试水平也比对照组结果要差(P<0.05)相关分析,可见肌肉量水平与几项肺功能水平指标[一秒用力呼气容积(Force expiratory volume one second,FEV1)、FEV1%predict]以及6MWD,均呈正相关(P<0.05)。回归模型分析的结果表明,基线肌肉量水平减低、女性、体脂率减低、维生素D水平减低为主要的危险因素。结论不同肌肉量水平COPD患者在同等治疗条件下肌少症者病情改善更迟缓,相对预后不佳;且女性、体脂率减低、维生素D水平减低是患者出现预后不佳的潜在危险因素。

Objective To investigate the difference of the disease progression in patients with chronic obstructive pulmonary disease(COPD)with different muscle mass levels and the influence of related factors on the disease progression.Methods A total of 308 newly diagnosed patients with COPD from February 2021 to February 2022 were selected for this study.All patients were below moderate COPD.The patients were divided into two groups according to their muscle mass levels:sarcopenia group(98 cases)and control group(210 cases).The diagnostic criteria for sarcopenia were based on sarcopenia diagnostic thresholds:RSMI<7.0 kg/m^(2)in men and<5.4 kg/m^(2)for women.All subjects were followed up for 4 months to observe the progress of the patient′s condition.The correlation between the muscle mass level and pulmonary function level,as well as the results of 6-minute walking test and CAT score was evaluated,and the influence of muscle mass level on the patient′s disease progress was analyzed.At the same time,the potential influence of related factors(body fat rate,vitamin D level,etc.)on the condition of patients with different muscle mass levels was discussed.SPSS 19.0 software was used to perform statistical analysis.Results Under the same treatment intervention,the baseline and follow-up lung function improvement levels of patients in the sarcopenia group were lower than those in the control group,and the difference was statistically significant(P<0.05).At the same time,the baseline and follow-up 6-minute walk test results of the patients in the sarcopenia group were also worse than those of the control group,and the difference was statistically significant(P<0.05).Further correlation analysis was carried out between the patient′s muscle mass level and the post-treatment pulmonary function indicators and 6MWD test level.The results showed that the muscle mass level was positively correlated with several pulmonary function indicators(FEV1,FEV1%predict)and 6MWD(both P<0.05).Considering the possible influence of other factors on the control and progress of the patient′s condition,the present study used follow-up CAT score results to distinguish the prognosis of the patient′s condition improvement,and used improvement and non-improvement as dependent variables to analyze the influence of various potential influencing factors.The results of regression model analysis showed that lower baseline muscle mass,women,lower body fat percentage,and lower vitamin D level were the main risk factors.Conclusion Under the same treatment condition,COPD patients with different muscle mass levels improve more slowly when complicated with sarcopenia and have poor prognosis.Women,lower body fat percentage and lower vitamin D level are potential risk factors for poor prognosis.