慢性阻塞性肺病患者瘦素水平与营养和呼吸肌力的相关性

目的研究慢性阻塞性肺病（COPD）患者的血清瘦素水平与营养状况和呼吸肌力的相关性。方法3l例病情稳定的COPD患者（A组），分为COPD营养不良组（A1组）和COPD非营养不良组（A2组）。以20例无吸烟史且肺功能正常的健康者作为对照组（B组）。测定各组的营养参数（血清瘦素水平、上臂肌围、血清白蛋白等）、肺通气功能、呼吸肌力（最大吸气压和最大呼气压）、呼吸中枢驱动功能（口腔闭合压）和动脉血气等指标，并行相关性分析。结果与A2组比较，Al组患者的血清瘦素水平等营养参数和PaO2均降低，而PaCO2增高；与B组相比，A组患者血清瘦素等营养参数、肺通气功能和呼吸肌力均降低，而口腔闭合压和PaCO2明显增高。A组血清瘦素水平与体重指数、上臂肌围和最大吸气压呈正相关；B组血清瘦素水平与其他营养参数和呼吸肌力无相关性。结论血清瘦素水平是COPD患者的营养状态指标并与呼吸肌力相关；COPD患者肺泡低通气和CO2蓄积的原因是外周呼吸肌力降低，而非呼吸中枢驱动功能不良。

Correlation of Serum Leptin Levels with Nutritional Parameters and Respiratory Muscle Strength in Patients with COPD

Objective To investigate the correlation of serum leptin with nutritional parameters and respiratory muscle strength in patients with COPD. Methods Thirty-one patients in stable state with COPD(group A) in our hospital were divided into malnutrition group(group A1)and non-malnutrition group(group A2).The control group(group B)consisted of 20 non-smokers with normal pulmonary function.The nutritional parameters(serum leptin, mid-arm muscle circumference,human serum albumin),pulmonary function,respiratory muscle strength(maximal aspiratory pressure,maximal expiratory pressure),function of respiratory center drive(oral cavity closure-pressure) and arterial blood gas analysis were detected,respectively,and analyzed relatively. Results The concentrations of serum leptin,parameters of nutritional status,pulmonary function,respiratory muscle strength and PaO_2 were lower in group A1 than those in group B(P<0.01).The concentration of serum leptin,parameters of nutritional status and respiratory muscle strength were lower,oral cavity closure-pressure and PaCO_2 were higher in group A than those in group B(P<0.01).The serum leptin had positive correlation with BMI and mid-arm muscle circumference as well as maximal aspiratory pressure in group A.The serum leptin had no correlation with nutritional parameter and respiratory muscle strength in group B. Conclusion Serum leptin is the parameter of nutritional metabolic state in patients with COPD and can affect respiratory muscle strength in patients with COPD.Alveolar hypoventilation and accumulation of carbon dioxide are due to reduction of respiratory muscle strength.The function of respiratory center drive is enhanced in patients with COPD.