慢性阻塞性肺疾病患者身体成分改变及合并肌肉减少症的影响因素研究

摘要

Objective To investigate the changes in body composition and associated factors for sarcopenia in patients with chronic obstructive pulmonary disease (COPD).Methods Ninety-six patients with COPD who were treated in The First Affiliated Hospital of Jinzhou Medical University from September to December 2016 were selected as the case group,and other 52 sex-and age-matched healthy adults underwent physical examination in the hospital during the same period were selected as the control group.All of them measured height,weight,BMI and body composition.In accordance with the definition and consensus diagnostic criteria developed by the European Working Group on Sarcopenia in Older People (EWGSOP),sarcopenia was identified by skeletal muscle mass index and gait speed.Univariate Logistic regression analysis and multiple stepwise Logistic regression analysis were performed to investigate the associated factors for COPD with sarcopenia.Results The measured values of weight,BMI,total-body skeletal muscle mass,trunk muscle mass,upper extremity skeletal muscle mass,lower extremity skeletal muscle mass,limb skeletal muscle mass,lean body mass,skeletal muscle index and lean body mass index were lower in male COPD patients than in male controls (P ＜ 0.05).Female COPD patients were found with higher values of weight,BMI,total-body skeletal muscle mass,trunk nuscle mass,upper extremity skeletal muscle mass,lower extremity skeletal muscle mass,limb skeletal muscle mass,lean body mass and skeletal muscle index compared with the female controls (P ＜ 0.05).The incidence of sarcopenia in case group was higher than that in the control group (P ＜ 0.05).The results of the univariate Logistic regression analysis showed that age,course of COPD and BMI are the associated factors of COPD with sarcopenia (P ＜ 0.05).Multivariate Logistic regression analysis showed that age,long-term smoking history,course of COPD,BMI are the associated factors of COPD with sarcopenia (P ＜ 0.05).Conclusion COPD patients are identified with significantly decreased muscle mass (total-body skeletal muscle mass,trunk muscle mass,upper extremity skeletal muscle mass,lower extremity skeletal muscle mass,limb skeletal muscle mass) and declined lean body mass.Moreover,they are prone to suffer from sarcopenia.Advanced age,long-term smoking,long course of COPD and decreased BMI are the risk factors.%目的 了解慢性阻塞性肺疾病(COPD)患者的身体成分改变,并探讨其合并肌肉减少症的影响因素.方法 选取2016年9-12月在锦州医科大学附属第一医院就诊的COPD患者96例为病例组;另于同期在本院体检者中,选取性别、年龄与病例组相匹配的健康成年人52例为对照组.检测并比较两组身高、体质量、BMI及身体成分情况;根据欧洲老年人肌肉减少症工作组(EWGSOP)制定的标准,以骨骼肌指数、步速为判断是否合并肌肉减少症的指标,采用单因素Logistic回归分析和多元逐步Logistic回归分析探讨COPD合并肌肉减少症的影响因素.结果 病例组男性体质量、BMI、全身肌肉量、躯干肌肉量、双上肢肌肉量、双下肢肌肉量、四肢肌肉量、去脂体质量、骨骼肌指数、去脂体质指数低于对照组男性,差异有统计学意义(P＜0.05);病例组女性体质量、BMI、全身肌肉量、躯干肌肉量、双上肢肌肉量、双下肢肌肉量、四肢肌肉量、去脂体质量、骨骼肌指数低于对照组女性,差异有统计学意义(P＜0.05).病例组肌肉减少症发生率高于对照组,差异有统计学意义(P＜0.05).单因素Logistic回归分析结果显示,年龄、病程、BMI是COPD合并肌肉减少症的影响因素(P＜0.05);多元逐步Logistic回归分析结果显示,年龄、长期吸烟史、病程、BMI是COPD合并肌肉减少症的影响因素(P＜0.05).结论 COPD患者肌肉量和去脂体质量明显低于健康者;COPD患者易合并肌肉减少症,高龄、长期吸烟、病程长、低BMI是其危险因素.