稳定期慢性阻塞性肺疾病患者骨骼肌质量和功能测定及其影响因素分析

目的探讨稳定期慢性阻塞性肺疾病(慢阻肺)患者的骨骼肌情况并分析其可能的影响因素。方法采用1∶1病例对照研究,连续纳入2018年7月1日至2019年12月31日中日友好医院慢阻肺多学科协作组符合稳定期慢阻肺纳入标准的220例患者为病例组。两组对照分别为同年龄段、同性别的社区健康者(社区对照组,220例)和年龄20~40岁的健康体检者(体检对照组,220例)。采用生物电阻抗技术测量身体成分,通过问卷调查患者的人口学特征、疾病情况、生活资料等相关因素并进行组间比较,组间比较采用t检验或单因素方差分析,非正态分布计量资料采用非参数检验。结果与社区对照组或与体检对照组比较,病例组患者体脂率(Z=-10.037,t=-8.411)、去脂体质量指数(Z=-8.165,Z=-7.856)、四肢骨骼肌质量指数(t=-7.158,t=-11.989)等均明显较低,差异均有统计学意义(均P<0.05)。220例稳定期慢阻肺患者中,符合肌肉衰减征诊断者51例(23.2%),其中男24例,占男性患者的18.3%(24/131);女27例,占女性患者的30.3%(27/89)。男女患者肌肉衰减征发生率差异有统计学意义(χ²=4.297,P=0.038)。慢阻肺合并肌肉衰减征患者中,年龄≥75岁(χ²=15.746,F=14.048)、女性(Z=5.805,t=2.672)、家庭人均月收入<2500元(Z=-4.291,t=-4.789)、慢阻肺的全球倡议分级Ⅳ级(χ²=22.644,F=3.905)、改良英国医学研究委员会呼吸困难量表分级4级(χ²=12.475,F=4.369)、未接受系统的健康教育(Z=-4.239,Z=-2.474)、不运动(χ²=14.786,F=3.402)、能量及蛋白均不足(χ²=40.531,F=10.529)者四肢骨骼肌质量指数和握力水平均偏低,差异均有统计学意义(均P<0.05);6 min步行试验距离为110~268(228±38)m,仅改良英国医学研究委员会呼吸困难量表(mMRC)分级4级者6 min步行试验距离更短(F=3.468,P<0.05)。结论慢阻肺患者普遍存在身体成分受损,且会进一步影响机体功能,建议常规评估中纳入身体成分及功能检测。

Body composition and sarcopenia in patients with stable chronic obstructive pulmonary disease(COPD)and its influencing factors

Objective To investigate the body composition and sarcopenia in patients with stable chronic obstructive pulmonary disease(COPD)and to analyze the influencing factors.Methods A total of 220 patients with stable COPD were enrolled in the study from China-Japan Friendship Hospital during July 2018 to December 2019;220 age and sex-matched healthy subjects(control group 1)and 220 healthy young adults aged 20-40 years(control group 2)were enrolled from the community.The body composition was measured by bioelectrical impedance method.The demographic characteristics,disease conditions,living background and other related factors were collected by questionnaire.T test or one-way ANOVA were used for comparison between groups,and non parametric test was used for non normal distribution data.Results Compared with the control group 1 and control group 2,the body fat rate(Z=-10.037,t=-8.411),the fat free mass index(Z=-8.165,t=-7.856),and appendicular skeletal muscle index(ASMI)(t=-7.158,t=-11.989)were significantly lower in stable COPD patients(P<0.05).Among 220 patients with stable COPD,51(23.2%)were diagnosed as sarcopenia;the prevalence of sarcopenia was 18.3%(24/131)in men and 30.3%(27/89)in women(χ²=4.297,P=0.038).The decreased ASMI and grip strength in COPD patients with sarcopenia were significantly associated with age≥75(χ²=15.746,F=14.048),female sex(Z=5.805,t=2.672),low income(Z=-4.291,t=-4.789),Global Initiative for Chronic Obstructive Lung Disease(GOLD)gradeⅣ(χ²=22.644,F=3.905),Modified British Medical Research Council(mMRC)Dyspnea Scale grade 4(χ²=12.475,F=4.369),not receiving systematic health education(Z=-4.239,Z=-2.474),no exercise(χ²=14.786,F=3.402),insufficient nutrition intake(χ²=40.531,F=10.529).The range of 6-min walking distance was(110-268)m,that was even shorter for patients with mMRC dyspnea scale grade 4(F=3.468,P<0.05).Conclusion The impairment of body composition is common in COPD patients,which will further affect the body function.It is suggested that the routine evaluation of COPD should include the measurement of body composition.