目的 分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者肌肉与脂肪状况,并探讨其与疾病发展过程的相关性.方法 选取COPD患者118例(研究组)与健康体检者97例(对照组),采用生物电阻抗、身高体重计测定两组患者的体重指数(body mass index,BMI)、去脂体重(fat-free mass,FFM)、骨骼肌(skeletal muscle mass,SMM)、四肢骨骼肌指数(appendicular skeletal muscle height index,ASMHI)、体脂率(percent body fat,PBF)、内脏脂肪面积(visceral fat area,VFA)、腰围(waist circumference,WaistCir)、上臂围(arm circumference,AC)、上臂肌围(arm muscle circumference,AMC)、相位角(phase angle,PA)等指标,并进行对比分析;同时收集COPD患者的基本信息、实验室指标及入院肺功能检查数据等,进行相关性分析;根据全球领导人营养不良倡议(Global Leadership Initiative on Malnutrition,GLIM)诊断标准,找出FFM在营养不良诊断中的最佳截断值.结果 研究组患者FFM、SMM、双下肢肌肉、ASMHI及AMC均低于对照组(P＜0.05).戒烟组患者BMI、PBF及VFA均高于持续吸烟组(P＜0.05);低ASMHI组第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、第1秒用力呼气容积占预计值百分比(forced expiratory volume in one second in predicted,FEV1％pred)、用力肺活量(forced vital capacity,FVC)及 1 秒率(FEV1/FVC)偏低;低ASMHI组中性粒细胞计数与淋巴细胞计数比值(neutrophil-lymphocyte ratio,NLR)高于正常ASMHI组(P＜0.05).GLIM诊断结果显示,50.8％COPD患者存在营养不良,其中FFM预测营养不良的最佳截断值为47.85kg.结论 COPD患者易出现肌肉和脂肪分布不平衡.FFM与GLIM诊断的一致性对早期识别和诊断营养不良有重要的临床意义.
Significance of Muscle Mass Evaluation for Nutritional Assessment and Diagnosis in Patients with COPD
Objective To analyze the muscle and fat status of patients with chronic obstructive pulmonary disease(COPD),and ex-plore the correlation with disease development.Methods One hundred and eighteen patients with COPD(study group)and 97healthy subjects(control group)were selected.Body mass index(BMI),fat-free weight(FFM),skeletal muscle index(SMM),appendicular skeletal muscle height index(ASMHI),percent body fat(PBF),visceral fat area(VFA),waist circumference(WaistCir),upper arm circumference(AC),upper arm muscle circumference(AMC),phase angle(PA)and other indicators were measured by bioelectrical impedance and height scale,and were compared and analyzed between the two groups.At the same time,the basic information,laboratory indicators and admission pulmonary function test data of patients with COPD were collected for correlation analysis.To identify the optimal cut-off value for FFM in the diagnosis of malnutrition according to the Global Leadership Initiative on Malnutrition(GLIM)diagnostic criteria.Results The FFM,SMM,lower limb muscles,ASMHI and AMC in study group were lower than those in the control group(P＜0.05).The BMI,PBF and VFA of the patients in the smoking cessation group were higher than those in the continuous smoking group(P＜0.05).The forced expiratory volume in one second(FEV1),forced expiratory volume in one second in predicted(FEV1％pred),forced vital capacity(FVC)and FEV1/FVC were lower in patients with low-ASMHI(P＜0.05).Neutrophil-lymphocyte ratio(NLR)was higher in the low-ASMHI group than taht in the normal ASMHI group(P＜0.05).The results of GLIM diagnostic showed that 50.8％of COPD patients were malnourished.The optimal cut-off value of FFM for predicting malnutrition was 47.85kg.Conclusion Patients with COPD are prone to unbalanced distribution of muscle and fat.The consistency of FFM with the diagnosis of GLIM has impor-tant clinical significance for the early identification and diagnosis of malnutrition.
万方数据
维普
