多频生物电阻抗技术评价 COPD 患者营养状况及其与血气分析指标的相关性

摘要

Objective To examine the body composition of COPD patients by multi - frequency bioelectrical impedance and investigate the relationship between body composition and blood gas indicators in order to provide clinical references for nutritional support for COPD patients. Methods We enrolled 62 patients who was hospitalized and diagnosed with COPD in the Department of Respiratory Medicine of Xinqiao Hospital from January to June in 2011. Multi - frequency bioelectrical impedance was used to detect the patients' physical composition. We collected data of serum total protein,albumin, prealbumin,hemoglobin,lymph cell count,blood gas( PaCO2 ,PaO2 and SpO2 ),HCO -3 ,Cl - ,K + ,Na + ,pH of the subjects at admission. Statistical analysis was conducted on the above indicators. Results The malnutrition rates assessed by ribosomal protein content,body fat content,BMI and MAC were 41. 9% ,17. 7% ,19. 4% and 16. 1% , respectively. According the BMI,the patients with inadequate,normal and excess nutrition were significantly different( P < 0. 05 )in ribosomal TBW,BFM,PBF,FFM,PBFF,protein content and PBP;the subjects with inadequate nutrition were higher(P <0. 05)than those with normal and high nutrition in PBP;the subjects with inadequate nutrition were lower( P < 0. 05)than those with normal and high nutrition in PBF and FFM. TBW,FFM,ribosomal protein,and SMM were negatively correlated with PaO2 ( r = - 0. 311, - 0. 306, - 0. 308, - 0. 306;P < 0. 05),and BMI was negatively correlated with SpO2 ( r =- 0. 304,P < 0. 05). Conclusion COPD patients have high malnutrition rate when assessed by ribosomal protein. FFM is more sensitive than BMI in nutritional evaluation of COPD patients. The increase of FFM in COPD patients may improve hypoxia tolerance.%目的：应用多频生物电阻抗技术分析 COPD 患者人体成分及其与血气分析指标的关系，为 COPD 患者的营养支持提供依据。方法选择2011年1—6月在新桥医院呼吸科住院并诊断为 COPD 患者62例，采用多频生物电阻抗法检测患者的人体成分，收集患者入院时的血清总蛋白、清蛋白、前清蛋白、血红蛋白、淋巴细胞计数及血气分析指标〔二氧化碳分压（PaCO2）、氧分压（PaO2）、血氧饱和度（SpO2）、HCO -3、Cl -、K ＋、Na ＋、pH 值〕，对相关指标进行统计分析。结果依据体蛋白质含量、体脂肪量（BFM）、体质指数（BMI）、上臂围（MAC）4种指标评价COPD 患者的营养状况，营养不足率分别为41.9％、17.7％、19.4％、16.1％。以 BMI 为分组标准，不同营养状况分组患者身体总水分（TBW）、BFM、体脂率（PBF）、无脂组织（FFM）、无脂肪组织体质量比（ PBFF）、体蛋白质含量、蛋白质体质量比（PBP）比较，差异均有统计学意义（P ＜0.05），其中营养不足组 PBP 高于营养正常组和营养过剩组，营养不足组 PBF 和 FFM 低于营养正常组和营养过剩组（ P ＜0.05）。TBW、FFM、体蛋白质含量、骨骼肌（SMM）与 PaO2呈负相关（ r ＝-0.311、-0.306、-0.308、-0.306，P ＜0.05），BMI 与 SpO2呈负相关（ r ＝-0.304，P ＜0.05）。结论依据体蛋白质含量评估 COPD 患者的营养不足率较高。相对于 BMI 常规营养评价指标， FFM 指标对 COPD 患者的营养状况评价更为敏感，并提示增加 COPD 患者 FFM 含量可能有益于提高其缺氧耐受性。