CAJ | 학술논문

目的探讨稳定期慢性阻塞性肺疾病(慢阻肺)患者的去脂质量指数与骨强度关系.方法纳入2013年3月至2014年1月的稳定期慢阻肺患者94例及健康吸烟者47名,所有受试者均为男性,其中慢阻肺组年龄45～79岁,平均(65±7)岁,对照组年龄40～79岁,平均(58±9)岁.测定肺功能、机体构成及骨强度,采用慢阻肺评估测试中文版问卷、mMRC量表评价慢阻肺患者症状、记录其最近12个月急性加重次数及因此住院次数并进行比较.正态分布数据用均数±标准差、非正态分布数据用中位数(四分位数间距)表示.符合正态分布的数据,若方差齐,采用t检验进行两组间比较;若方差不齐,则采用t’检验进行两组间比较.结果稳定期慢阻肺组患者合并肌肉萎缩[去脂质量指数(FFMI)＜ 16 kg/m2]和骨折高风险[骨强度指数(SI)T＜-1]的发生率分别为24.5％ (23/94)和72.3％(68/94).合并肌肉萎缩的慢阻肺患者与肌肉体积正常的患者相比,FEV1占预计值％降低[(39±15)％,(50±16)％]、最近12个月急性加重次数增加[1.0(0～3.0),0(0～1.0)]、骨强度指数降低[(76±13)％,(86±16)％,t值和t’值分别为2.904,-1.476,2.728,均P＜0.05],存在骨折高风险的慢阻肺患者与骨折低风险的患者相比,mMRC评分增加[2.0(1.0 ～3.0)和1.0(0～2.0)](Z值为-2.297,P＜0.05).慢阻肺患者去脂指数与骨强度指数呈正相关(r=0.294,P＜0.05).结论合并肌肉萎缩和骨折高风险的稳定期男性慢阻肺患者肺功能降低,未来急性加重风险增加,二者呈正相关,慢阻肺患者应注意筛查上述合并症.
목적 탐토은정기만성조새성폐질병(만조폐)환자적거지질량지수여골강도관계.방법 납입2013년3월지2014년1월적은정기만조폐환자94례급건강흡연자47명,소유수시자균위남성,기중만조폐조년령45～79세,평균(65±7)세,대조조년령40～79세,평균(58±9)세.측정폐공능、궤체구성급골강도,채용만조폐평고측시중문판문권、mMRC량표평개만조폐환자증상、기록기최근12개월급성가중차수급인차주원차수병진행비교.정태분포수거용균수±표준차、비정태분포수거용중위수(사분위수간거)표시.부합정태분포적수거,약방차제,채용t검험진행량조간비교;약방차불제,칙채용t’검험진행량조간비교.결과 은정기만조폐조환자합병기육위축[거지질량지수(FFMI)＜ 16 kg/m2]화골절고풍험[골강도지수(SI)T＜-1]적발생솔분별위24.5％ (23/94)화72.3％(68/94).합병기육위축적만조폐환자여기육체적정상적환자상비,FEV1점예계치％강저[(39±15)％,(50±16)％]、최근12개월급성가중차수증가[1.0(0～3.0),0(0～1.0)]、골강도지수강저[(76±13)％,(86±16)％,t치화t’치분별위2.904,-1.476,2.728,균P＜0.05],존재골절고풍험적만조폐환자여골절저풍험적환자상비,mMRC평분증가[2.0(1.0 ～3.0)화1.0(0～2.0)](Z치위-2.297,P＜0.05).만조폐환자거지지수여골강도지수정정상관(r=0.294,P＜0.05).결론 합병기육위축화골절고풍험적은정기남성만조폐환자폐공능강저,미래급성가중풍험증가,이자정정상관,만조폐환자응주의사사상술합병증.
Objective To determine the body composition and bone stiffness in patients with stable chronic obstructive pulmonary disease (COPD),and to explore the association between them.Methods Ninety-four male COPD patients in stable conditions and 47 healthy smokers were recruited from March 2013 to January 2014.Lung function,body composition and bone stiffness were measured.In COPD patients,the symptoms were assessed by COPD Assessment Test (CAT) and Modified British Medical Research Council (mMRC) respectively,and the acute exacerbation and hospitalization history in the previous 12 months were also recorded.Results The prevalence of muscle atrophy (FFMI ＜ 16 kg/m2) and high risk of bone fracture(T ＜-1) were 24.5％ and 72.3％ respectively in stable male COPD patients.The patients with muscle atrophy,had lower FEV1％ pred (39.0 ± 15.2) vs (50.1 ± 16.2),frequent acute exacerbations [1.0(0-3.0) vs 0(0-1.0)] and lower bone stiffness index(75.5 ± 13.3) vs (85.5 ± 15.7),(test values were 2.904,-1.476,2.728,all P ＜ 0.05).Compared with patients with low risk of bone fracture (T ≥-1),patients with high risk of bone fracture (T ＜-1) showed higher mMRC score [2.0 (1.0-3.0) vs 1.0(0-2.0)] (Z =-2.297,P ＜ 0.05).The FFMI correlated positively with SI (r =0.294,P =0.004) in COPD patients.Conclusions Patients with stable COPD presented worse lung function and increased risk of future exacerbations when combined with muscle atrophy and high risk of bone fracture,and the two co-morbidities were correlated and should be assessed.