慢性阻塞性肺疾病患者体重指数和骨密度 骨骼肌功能相关性研究  

Correlation study of body mass index with bone mineral density and skeletal muscle function in patients with chronic obstructive pulmonary disease

作　　者：丁怿虹[1] 施劲东[2] 刘勤[3] 诸卫英[1] 唐建国[1] 陈德昌[4] 

机构地区：[1]复旦大学附属上海市第五人民医院急诊科,上海200240 [2]复旦大学附属上海市第五人民医院呼吸科,上海200240 [3]复旦大学附属上海市第五人民医院老年科,上海200240 [4]第二军医大学附属长征医院急诊科,上海200003

出　　处：《中国实用内科杂志》2016年第8期675-679,共5页Chinese Journal of Practical Internal Medicine

基　　金：上海市闵行区自然科学基金项目(2012MW13;2010MHZ018);上海市卫生局青年科研项目(2010Y036)

摘　　要：目的探讨体重指数(BMI)在慢性阻塞性肺疾病(慢阻肺)营养状态、骨密度和骨骼肌功能评估中的价值。方法测定2012年5月至2015年5月复旦大学附属上海市第五人民医院门诊及住院56例慢阻肺稳定期患者(低BMI组26例、正常BMI组30例)及30例健康体检者(对照组)的营养指标(身高、体重、血浆白蛋白)、骨密度、骨代谢指标[1型胶原氨基末端前肽(PINP)、血抗酒石酸盐酸性磷酸酶(TRAP)、尿脱氧吡啶啉(DPD)]、肌电图(神经传导时间、动作电位波幅)、肺功能、动脉血气分析、6 min步行距离(6MWD),分析BMI与骨密度和骨骼肌功能的相关性。结果 (1)低BMI组血浆白蛋白、动脉血氧分压(PaO_2)、第一秒用力呼吸容积占预计值百分比(FEV1%pred)、第一秒用力呼气容积与用力肺活量比值(FEV1/FVC)、最大自主通气量(MVV)、6MWD低于正常BMI组和对照组(P<0.05);(2)低BMI组、正常BMI组TRAP和DPD均高于对照组(P<0.05);3组PINP差异无统计学意义(P>0.05);低BMI组骨密度(L1-L4、全髋)指标均低于正常BMI组患者和对照组(均P<0.05)。(3)低BMI组膈神经、股神经动作电位时间明显高于正常BMI组和对照组(均P<0.05),低BMI组膈神经、股神经动作电位幅度明显低于正常BMI组(P<0.05)和对照组(P<0.05)。(4)BMI与PINP无相关性(r=0.164,P=0.248),与TRAP、DPD呈显著负相关(r分别为-0.451和-0.463,P<0.05),与骨密度(L1-L4)、骨密度(全髋)呈正相关(r分别为0.650和0.681,P<0.05),BMI与膈神经动作电位时间(r=-0.351,P=0.011)、股神经动作电位时间(r=-0.382,P=0.000)呈显著负相关,BMI与膈神经传导幅度(r=0.455,P=0.001)、股神经传导幅度(r=0.701,P=0.002)呈显著正相关。结论 BMI与慢阻肺患者骨密度、骨骼肌功能密切相关,可以作为同时评估慢阻肺患者营养状态、骨质疏松和骨骼肌功能的指标,对慢阻肺综合评估和治疗有积极的指导作用。Objective To explore the effectiveness of body mass index （BMI） in evaluating nutrition, bone mineral density and skeletal muscle function in patients with chronic obstructive pulmonary disease（COPD）. Methods We studied fifty-six patients with COPD in stabilized phase and thirty healthy volunteers.＇Ihe COPD patients were divided into two groups according to the BMI： 26 in low BMI group and 30 in normal BMI group.The＇nutritional indexes （height, weight and albumin）, bone mineral densiW, bone metabolism indexes [human amino-terminal propeptide of type I procollagen （PINP）, tartrate resistant acid phosphatase （TRAP） and deoxypyridinoline （DPD）], electromyography （nerve conduction time, action potentials amplitude）, pulmonary function, arterial blood gas analysis and 6-minute walk test of all volunteers were determined to evaluate the correlation of BMI with bone mineral density and skeletal muscle fimction. Results （1）The measured values of albumin, PaO2, FEV1%Pred, FEVI/FVC, MVV and 6MWD were lower in low BMI patients than those in patients with normal BMI and healthy volunteers（P〈0.0S）. （2）The levels of TRAP and DPD in all COPD patients were higher than healthy volunteers（P〈0.0S）. As for PINP, no statistical differences were found between the three groups（P〉0.0$）. The bone mineral density （L1-L4, hip joint） of low BMI COPD patients was lower than that of patients with normal BMI and healthy controls（P〈0.05）. （3）Phrenic nerve and femoral nerve action potential conduction time was longer in low BMI COPD patients than that in normal BMI patients （P〈0.05）and healthy controls （/9〈0.05）. The action potentials amplitude was lower in low BMI COPD patients than that in normal BMA patients （P〈0.05）and healthy controls （P〈0.05）. （4）There was no correlation between the BMI and PINP（r=0.164, P=0.248）. A significant negative correlation could be found between the BMI and TRAP （r=-0.451, P=0.001）, DPD （r=-0.463, P=0.00

关 键 词：慢性阻塞性肺疾病 体重指数 骨骼肌功能 骨密度 肌电图 

分 类 号：R593.22[医药卫生—内科学]