慢性阻塞性肺疾病急性加重期患者体成分的临床评价

Clinical Evaluation of Body Composition in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者的体成分与疾病恶化风险和肌源性microRNA(myomiRs)表达水平的相关性。方法选取2021年2月-2022年12月在福建医科大学附属第二医院就诊的77例AECOPD患者的基本资料和血液样本,采用人体成分分析仪测量体成分,运用逆转录-聚合酶链式反应技术检测血浆中myomiRs含量。将每年加重2次或2次以上的患者列入高恶化风险组(55例),少于2次的列入低恶化风险组(22例)。比较两组体成分差异,探索其与疾病恶化和血浆myomiRs水平的关系。结果高恶化风险组去脂体重、去脂体重指数与相位角低于低恶化风险组,细胞外水分比率高于低恶化风险组,差异有统计学意义(P<0.05);高恶化风险组的细胞内液与身体总水分低于低恶化风险组(P<0.05);逻辑回归分析显示,细胞外水分比率(OR=1.086,95%CI:1.010~1.168,P=0.026)和相位角(OR=0.396,95%CI:0.164~0.957,P=0.040)与疾病恶化风险独立相关。依据受试者工作特征曲线,鉴别恶化风险时,细胞外水分比率与相位角的阈值分别是0.393%和4.85°;AECOPD患者的脂肪参数(脂肪量、脂肪指数、体脂百分比和内脏脂肪面积)与miR-206表达水平呈负相关。结论细胞外水分比率和相位角可用于鉴别AECOPD患者恶化风险。此外,miR-206与AECOPD患者的脂肪参数相关,表明脂肪可能参与患者肌肉衰减症的调控过程。

Objective To analyze the correlation between body composition and the risk of disease progression and the expression level of myogenic microRNAs(myomiRs)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The basic data and blood samples of 77 patients with AECOPD who were treated in the Second Affiliated Hospital of Fujian Medical University from February 2021 to December 2022 were selected.The body composition was measured by the body composition analyzer,and the content of myomiRs in plasma was detected by reverse transcription-polymerase chain reaction.Patients with two or more exacerbations per year were included in the high deterioration risk group(55 patients)and those with less than two exacerbations were included in the low deterioration risk group(22 patients).The differences in body composition between the two groups were compared to explore its relationship with disease progression and plasma myomiRs levels.Results The fat-free weight,fat-free body mass index and phase angle of the high deterioration risk group were lower than those of the low deterioration risk group,and the extracellular water ratio was higher than that of the low deterioration risk group,the difference were statistically significant(P<0.05).The intracellular fluid and total body water in the high deterioration risk group were lower than those in the low deterioration risk group(P<0.05).Logistic regression analysis showed that extracellular water ratio(OR=1.086,95%CI:1.010-1.168,P=0.026)and phase angle(OR=0.396,95%CI:0.164-0.957,P=0.040)were independently associated with the risk of disease progression.According to the receiver operating characteristic curve,the thresholds of extracellular water ratio and phase angle were 0.393%and 4.85°,respectively.The fat parameters(fat mass,fat index,body fat percentage and visceral fat area)of AECOPD patients were negatively correlated with the expression level of miR-206.Conclusion The extracellular water ratio and phase angle can be used to identify the deterioration risk of AECOPD patients.In addition,miR-206 is associated with fat parameters in patients with AECOPD,indicating that fat may be involved in the regulation of sarcopenia in patients.