CAJ | 학술논문

目的探讨低体质指数(BMI)的慢性阻塞性肺疾病(COPD)患者的临床特征及与COPD患者BMI相关的因素. 方法选取中、重度稳定期COPD患者38例,测量身高、体质量,按BMI分为低体质量组:16例,BMI<20}正常体质量组22例,20≤BMI<26.所有患者行肺功能检查;记录吸烟指数;测6 min步行距离(6MWD);采用英国医学研究委员会呼吸困难量表(MRC)记录气促分级并评分;St George's呼吸问卷(SGRQ)和一般健康状况调查问卷(SF-36)评价生活质量,用酶联免疫吸附试验(ELISA)测定血清瘦素、格列林的水平. 结果低体质量组与正常体质量组比较,深吸气量(IC)明显降低(P<0.01);第1秒用力呼气量(FEVl)、肺活量(VC)、最大通气量(MVV)、最大呼气峰值流速(PEF)均下降(P<0.05);残气量与肺总量比值(RV/TLC)明显增高(P<0.01).低体质量组吸烟指数增加,6MWD减少(P<0.05),MRC气促评分增高(P<0.01).低体质量组SGRQ评分中活动分、影响分与总均分增高(P<0.05),SF-36量表中情感职能、社会功能评分明显减低(P<0.05).低体质量组瘦素水平明显降低(P<0.01),格列林水平增高(P<0.05).经多元逐步回归分析发现,与BMI独立相关的因素分别是:IC、SF-36量表的精神健康和生理机能、瘦索、6MWD、吸烟指数. 结论低BMI COPD患者肺功能、营养状况、运动能力及生活质量较正常BMI患者下降;IC与BMI关系最密切,患者的精神健康、运动能力、血清瘦素水平、吸烟指数均与BMI独立相关;纠正低BMI应为COPD综合治疗的重要组成部分.
목적 탐토저체질지수(BMI)적만성조새성폐질병(COPD)환자적림상특정급여COPD환자BMI상관적인소. 방법 선취중、중도은정기COPD환자38례,측량신고、체질량,안BMI분위저체질량조:16례,BMI<20}정상체질량조22례,20≤BMI<26.소유환자행폐공능검사;기록흡연지수;측6 min보행거리(6MWD);채용영국의학연구위원회호흡곤난량표(MRC)기록기촉분급병평분;St George's호흡문권(SGRQ)화일반건강상황조사문권(SF-36)평개생활질량,용매련면역흡부시험(ELISA)측정혈청수소、격렬림적수평. 결과 저체질량조여정상체질량조비교,심흡기량(IC)명현강저(P<0.01);제1초용력호기량(FEVl)、폐활량(VC)、최대통기량(MVV)、최대호기봉치류속(PEF)균하강(P<0.05);잔기량여폐총량비치(RV/TLC)명현증고(P<0.01).저체질량조흡연지수증가,6MWD감소(P<0.05),MRC기촉평분증고(P<0.01).저체질량조SGRQ평분중활동분、영향분여총균분증고(P<0.05),SF-36량표중정감직능、사회공능평분명현감저(P<0.05).저체질량조수소수평명현강저(P<0.01),격렬림수평증고(P<0.05).경다원축보회귀분석발현,여BMI독립상관적인소분별시:IC、SF-36량표적정신건강화생리궤능、수색、6MWD、흡연지수. 결론 저BMI COPD환자폐공능、영양상황、운동능력급생활질량교정상BMI환자하강;IC여BMI관계최밀절,환자적정신건강、운동능력、혈청수소수평、흡연지수균여BMI독립상관;규정저BMI응위COPD종합치료적중요조성부분.
Objective To study the characteristics of patients with low body mass index (BMI) chronic obstructive pulmonary disease(COPD). Methods A total of 38 clinically stable patients with moderate-to-severe COPD were enrolled. They were divided into two groups: underweight (UW) group (n=16,BMI<20);normal weight(NW) group(n=22, 20≤BMI<26). Body height and weight, smoking indexs, and six minutes walk distance (6MWD) were assayed. The British Medical Research Council (MRC) dyspnea scale was used to assess the degree of dyspnea. St. George's Respiratory Questionnaire (SGRQ) and Short Form 36 item Questionnaire (SF-36) were used for health-related quality of life (HRQoL) evaluation. The serum concentrations of leptin and ghrelin were detected by enzyme-linked immunosorbent assay (ELISA). Results Compared with the NW group, the inspiratory eapacity(IC), forced expiratory volume in one second (FEV), vital capacity (VC) ,most ventilate volume (MVV) and peak expiratory flow(PEF) were lower(P<0. 05) in the UW group. Residual volume-to-total lung capacity ratio (RV/TLC), smoking indexs and MRC score were higher (all P<0. 05) and 6MWD was significantly lower (P<0. 05) in the UW group than in NW group. Activity scores,impact scores and total scores of SGRQ showed significant deterioration in the UW group (P<0. 05). SF-36 also showed significantly worse scores for the parameters of the emotional and social functioning (P < 0. 05 ). Serum leptin was significantly lower ( P< 0.01 ) and ghrelin was higher in UW group than in NW group (P<0. 05). Stepwise multiple regression analyse showed that lC,mental health(MH) and physical function (PF) of SF-36, leptin,6MWD and smoking indexs were independently correlated with BMI. Conchtsions The pulmonary function, nutritional status, PF and life quality of COPD patients with low BMI were more deteriorative. The most significant influencing factor for BMI in COPD patients was IC. M H,exercise capacity,leptin level and smoking indexs were independently correlated with BMI in COPD patients. It is important to retrieve low BMI in the management of COPD patients.