男性稳定期COPD患者去脂体质量指数与临床特征及血清炎症因子的相关性研究  

Correlation of fat free mass index with clinical features and serum inflammatory factors in male chronic obstructive pulmonary disease patients

作　　者：凌琳[1] 缪晔红 沈莹莹 张秀琴[1] 黄建安[1] Ling Lin;Miao Yehong;Shen Yingying;Zhang Xiuqin;Huang Jian′an(Department of Respiratory Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院呼吸科,215000

出　　处：《国际呼吸杂志》2020年第20期1549-1555,共7页International Journal of Respiration

基　　金：苏州市科技计划项目(SS201813)。

摘　　要：目的探讨男性稳定期慢性阻塞性肺疾病(COPD)患者营养状态和全身炎症反应水平的关系。方法选取2017年2月至2018年2月在苏州大学附属第一医院呼吸内科门诊就诊的男性稳定期COPD患者86例、男性正常对照组51例进行回顾性分析,采用去脂体质量指数(FFMI)对受试者进行营养状态评估,将COPD组分为低FFMI组(n=44)和正常FFMI组(n=42),对所有受试者进行症状评分、6分钟步行距离(6MWD)、肺功能检测,同时检测所有受试者的血清肿瘤坏死因子α(TNF-α)、血清白细胞介素18(IL-18)浓度。结果稳定期COPD组体质量、体质量指数(BMI)、6MWD、第1秒用力呼气容积占预计值百分比(FEV1%pred)、FEV1/FVC均显著低于正常对照组(P<0.001)。稳定期COPD组营养不良发生率明显高于正常对照组,差异有统计学意义(χ2=23.837,P<0.05)。稳定期COPD组血清TNF-α、IL-18水平均高于正常对照组,2组间差异有统计学意义(P<0.05)。低FFMI组血清TNF-α、IL-18水平明显高于正常FFMI组,2组间差异有统计学意义(P<0.05)。稳定期COPD患者的FFMI与6MWD、FEV1%pred、FEV1/FVC均呈正相关(r=0.416、0.377、0.390,P值均<0.05)。而入组前一年急性加重次数、mMRC评分、血清TNF-α、血清IL-18与FFMI呈负相关(r=-0.437、-0.439、-0.506、-0.337,P值均<0.05),其中血清TNF-α与FFMI呈负相关。采用逐步法多元线性回归分析,6MWD、血清TNF-α浓度、血清IL-18浓度是FFMI独立影响因素(b=0.008、-0.240、-0.004,P值均<0.05)。通过标准化回归系数发现血清TNF-α水平与FFMI相关性最高(β=-0.436,P<0.001)。结论COPD患者血清TNF-α与营养不良指标关系密切,是COPD营养不良的独立预测因子。Objective To investigate the relationship between nutritional status and systemic inflammatory response in male patients with stable chronic obstructive pulmonary disease(COPD).Methods A total of 86 male patients with stable COPD and 51 male normal controls were enrolled in the First Affiliated Hospital of Soochow University from February 2017 to February 2018.Subjects were assessed for nutritional status using a fat-free body mass index.Symptom scores,six-minute walking distance(6MWD),and lung function tests were performed on all subjects.Serum tumor necrosis factor-α(TNF-α)and serum interleukin-18(IL-18)concentrations were also measured in all subjects.Results Body weight,body mass index(BMI),6MWD,forced expiratory volume in one second as a percentage of expected value(FEV1%pred),and FEV1/FVC were significantly lower in the stable COPD group than in the normal control group(P<0.001).The incidence of malnutrition in the stable COPD group was significantly higher than that in the normal control group,and the difference was statistically significant(χ2=23.837,P<0.05).Serum levels of TNF-αand IL-18 in the stable COPD group were higher than those in the normal control group,and the difference was statistically significant(P<0.05).The levels of serum TNF-αand IL-18 in the low FFMI group were significantly higher than those in the normal FFMI group(P<0.05).The FFMI of patients with stable COPD was positively correlated with the six-minute walking distance,the FEV1%pred,and the FEV1/FVC(r=0.416,0.377,0.390,all P<0.05).mMRC score,serum TNF-αconcentration,serum IL-18 concentration were negatively correlated with FFMI(r=-0.437,-0.439,-0.506,-0.337,all P<0.05).There was a strong negative correlation between serum TNF-αconcentration and FFMI.Using stepwise multiple linear regression analysis,6MWD,serum TNF-αconcentration,serum IL-18 concentration were independent factors affecting FFMI(b=0.008,-0.240,-0.004,all P<0.05).Serum TNF-αlevels were most correlated with FFMI by standardized regression coefficients(β=-0.43

关 键 词：肺疾病 慢性阻塞性 营养不良 去脂体质量指数 炎症反应 

分 类 号：R563.9[医药卫生—呼吸系统]