慢性阻塞性肺疾病患者体质量指数与肺功能及HRCT气道重塑参数的相关性研究

目的探讨低体质量指数（bodymassindex，BMI）cOPD患者肺功能受损程度、临床及影像学特征。方法选取COPD急性加重期患者62例，根据BMI分为4组：低体重组（BMI％18．5kg／m2）、正常体重组（BMI18．5～23．9kg／m2）、超重组（BMI24．0H27．9kg／m2）、肥胖组（BMI≥28kg／m2）。所有患者进行慢性阻塞性肺疾病自我评估测试（COPDassessmenttest，CAT）问卷、肺功能检测及高分辨CT（highresolutionCT，HRcT）检查，并同时应用HRCT相关软件测定肺气肿评分、气道壁厚度及管腔面积等气道重塑指标。观察各组上述指标的变化，并研究其与BMI的相关性。结果①所有患者中低体重组患者12例，正常体重组患者30例，超重组患者7例，肥胖组患者13例，各组患者的年龄、性别、吸烟指数差异无统计学意义；②与正常体重、超重及肥胖患者比较，低体重患者FEV。％pred、MVV、Dt．co／VA％pred、FEV，／FVC均下降（P〈0．05），而RV／TLc增高（P〈0．05）；③与正常体重、肥胖患者比较，低体重患者CAT评分增高（Pd0．05）；④与正常体重、超重及肥胖组患者比较，低体重组患者肺气肿评分高（Pd0．05）；⑤低体重患者管壁面积百分比（WA％pred）、壁厚与外径比率（TDR％pred）与各组间差异无统计学意义（P〉0．05）；⑥BMI与CAT评分、肺气肿评分、RV／TLC均呈负相关（r=-0．351，P〈0．05；r=-0．628，P〈0．05；r=-0．256，P〈0．05），而与WA％pred、TDR％pred无相关性（P〉0．05）；BMI与FEV1／FVC、DLCO／VA％pred呈正相关（r=0．387，P〈0．05；r=0．549，P〈0．05）。结论低BMI的COPD患者肺气肿程度严重，通气及弥散功能明显下降，这对临床综合评估COPD病情的严重程度有一定帮助。

Correlation between body mass index and pulmonary function and HRCT in measuring airway remodeling in patients with chronic obstructive pulmonary disease

Objective To explore the impaired degree of pulmonary function, clinical and imaging characteristics of chronic obstructive pulmonary disease （COPD） patients with low body mass index （BMI）. Methods Select 62 patients with acute exacerbations of COPD. According to the BMI （kg/m2 ）, we divided the patients into four groups： low body weight （BMI18.5 kg/m2）, normal weight group （BMI 18.5-23.9 kg/m2 ）, overweight （BMI 24.0-27.9 kg/m2 ）, obesity group （BMI28 kg/m2 ）. AI1 patients completed the COPD self assessment test （COPD assessment test, CAT） questionnaire, pulmonary function test,and high resolution CT （HRCT）. At the same time, the application of software measure emphysema score, airway wall thickness, lumen area wall and other airway remodeling index. Observe the changes of above indexes,and study its correlation with BMI. Results （DAmong all patients, 12 patients were in low body weight group,30 patients were in normal body weight group,7 patients were in overweight group, 13 patients were in obesity group, and there was no statistical difference between groups of patients with age, gender, smoking index. Compared with normal weight, overweight and obese patients, FEV1% pred, MVV, DLCO/VA pred and FEVt/FVC were much lower in low body weight patients （ P 〈 0.05）, but RV/TLC was much higher （ P 〈 0.05）. （2） Compared with normal weight and obese patients,CAT scores were much higher in low body weight patients （P〈0.05）. （5） Compared with normal weight,overweight and obese patients, emphysema score was much higher （ P〈 0.05）. （2）There was no statistical difference between low body weight group and other three groups with wall area percentage of airway diseases （WA% pred） and wall thickness and diameter ratio （TDR%pred） （P〈0.05）. （6） BMI of COPD patients was negatively correlated with the CAT score, pulmonary emphysema score,andRV/TLC （r=-0.351, P〈0.05. r =-0.628, P〈0.05. r =-0.256, P〈 0.05） ,but BMI had no correlat