摘要
目的探索稳定期慢性阻塞性肺疾病(简称慢阻肺)患者的代谢表型分布。方法收集2018年9月至2019年12月在北京医院呼吸与危重症医学科门诊就诊且年龄≥40岁的57例慢阻肺稳定期患者。收集变量:一般资料,症状评分[慢性阻塞性肺疾病评估测试(CAT)评分与改良英国医学研究委员会呼吸困难指数(mMRC)评分]、运动耐力测定(6 min步行试验)、肺功能检测、人体成分分析、静息能量消耗、代谢和营养的血液学指标、细胞因子等。结果57例稳定期慢阻肺患者营养代谢表型分布:肥胖组3例(5.3%),恶病质组14例(24.6%),肌少症组10例(17.5%),30例(52.6%)患者为正常体型组,根据欧洲代谢表型的标准该研究的营养不良患病率42.1%。肥胖组慢阻肺患者的四肢骨骼肌质量[28.6(23.5,34.0)kg]、去脂肪组织质量[62.3(54.0,76.6)kg]、去脂肪组织质量指数[20.8(19.1,23.1)kg/m^(2)]、骨矿物质含量[3.2(3.0,4.2)kg]、吸药后第1秒用力肺活量占预计值百分比(FEV1%)[56.8(40.0,56.8)]在4组中最高,而CAT评分[3.0(3.0,5.0)分]、mMRC评分[0(0,2.0)分]和BODE指数[1.0(1.0,2.0)分]在4组中最低(P<0.05)。肌少症组慢阻肺患者的去脂肪组织质量指数[15.9(14.7,16.9)kg/m2]、静息能量消耗(REE)[1034.0(876.5,1156.8)kcal/d]和FEV1%[49.5(39.2,63.9)]在4组中最低,而CAT评分[13.0(6.5,17.5)分]、mMRC评分[2.0(1.5,2.0)分]和BODE指数[3.0(2.0,6.0)分]在4组中最高(P<0.05)。恶病质前期和恶病质组的慢阻肺患者的体脂肪组织质量[12.0(8.2,18.9)kg]、四肢骨骼肌质量[19.8(18.1,23.2)kg]、去脂肪组织质量[46.1(43.4,52.4)kg]、内脏脂肪面积[56.6(41.8,89.1)cm2]在4组中最低(P<0.05)。肿瘤坏死因子α在肌少症组最高[32.9(27.6,118.3)pg/mL](P<0.05)。结论慢性阻塞性肺疾病患者分布于各营养代谢表型,各表型之间人体成分测量差异明显。
Objective To explore the distribution of metabolic phenotypes in patients with stable chronic obstructive pulmonary disease(COPD).Methods From September 2018 to December 2019,57 patients with stable COPD aged over 40 years were collected from the outpatient department of pulmonary and critical care medicine of Beijing hospital.Main variables:general data,symptom score(CAT score,mMRC score),exercise endurance test(6-minute walking test),lung function test,body composition analysis,resting energy consumption,hematological indexes of stress metabolism and nutrition,cytokines.Results The distribution of metabolism phenotypes in 57 patients with stable COPD:3 cases(5.3%)in obesity group,14 cases(24.6%)in cachexia group,10 cases(17.5%)in sarcopenia group,and 30 cases(52.6%)in normal group.According to the metabolic phenotype standard of European Respiratory Society,the prevalence of malnutrition in this study was 42.1%.The average appendicular skeletal muscle mass[28.6(23.5,34.0)kg],the average fat-free mass[62.3(54.0,76.6)kg],the fat-free mass index[20.8(19.1,23.1)kg/m2],the average bone mineral content[3.2(3.0,4.2)kg]and FEV1%after inhalation[56.8(40.0,56.8)]of COPD patients in obesity group were the highest among the four groups,while CAT score[3.0(3.0,5.0)],MMRC score[0(0,2.0)]and BODE index[1.0(1.0,2.0)]were the lowest in the four groups(P<0.05).The fat-free mass index[15.9(14.7,16.9)kg/m^(2)],REE[1034.0(876.5,1156.8)kcal/d]and FEV1%[49.5(39.2,63.9)]of COPD patients in sarcopenia group were the lowest among the four groups,while CAT score[13.0(6.5,17.5)],MMRC score[2.0(1.5,2.0)]and BODE index[3.0(2.0,6.0)]were the highest among the four groups(P<0.05).The body fat mass[12.0(8.2,18.9)kg],appendicular skeletal muscle mass[19.8(18.1,23.2)kg],fat-free mass[46.1(43.4,52.4)kg]and visceral fat area[56.6(41.8,89.1)cm2]of COPD patients in precachexia and cachexia group were the lowest among the four groups(P<0.05).TNF-α was the highest in sarcopenia group[32.9(27.6,118.3)pg/mL P<0.05)with statistical significance.Conclusi
作者
居阳
王和
李冠臻
王丁一
李燕明
Ju Yang;Wang He;Li Guanzhen;Wang Dingyi;Li Yanming(Department of Pulmonary and Critical Care Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatrics Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;不详)
出处
《中国临床保健杂志》
CAS
2021年第5期599-605,共7页
Chinese Journal of Clinical Healthcare
基金
北京医院院内课题(BJ-2018-004)。
关键词
肺疾病
慢性阻塞性
营养状况
身体成分
Pulmonary disease,chronic obstructive
Nutritional status
Body composition
