社区轻中度慢性阻塞性肺疾病患者BMI与自我报告急性加重关联的前瞻性研究  

Association of BMI with acute exacerbation in mild to moderate chronic obstructive pulmonary disease patients in community:a prospective study

作　　者：阮晓楠[1,2] 徐芊 吴抗 侯珊珊[2,3] 王小楠 周鑫 李智韬[1,2] 柯居中 刘晓琳 陈晓丹 刘庆平[1,2] 林涛 付朝伟[2,3] 王娜 Ruan Xiaonan;Xu Qian;Wu Kang;Hou Shanshan;Wang Xiaonan;Zhou Xin;Li Zhitao;Ke Juzhong;Liu Xiaolin;Chen Xiaodan;Liu Qingping;Lin Tao;Fu Chaowei;Wang Na(Pudong New District Center for Disease Control and Prevention of Shanghai,Shanghai 200136,China;Pudong Preventive Medicine Research Institute,Fudan University,Shanghai 200136,China;Department of Epidemiology,School of Public Health,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市浦东新区疾病预防控制中心,上海200136 [2]复旦大学浦东预防医学研究院,上海200136 [3]复旦大学公共卫生学院流行病学教研室,上海200032

出　　处：《中华流行病学杂志》2022年第9期1441-1447,共7页Chinese Journal of Epidemiology

基　　金：国家自然科学基金委面上项目(82073634);上海市浦东新区卫健委2017年面上项目(PW2017A-9)。

摘　　要：目的研究BMI与轻中度慢性阻塞性肺疾病(COPD)患者急性加重的关联。方法研究对象来源于上海市浦东新区2014年建立的COPD确诊患者注册登记系统,采用整群抽样选取8个社区的COPD患者,并进行3次共18个月的前瞻性随访。基线调查获取患者基本信息及BMI数据,并收集随访期间的急性加重情况,多元负二项回归分析BMI与急性加重发生风险之间的关联。结果328名研究对象中,有295名社区COPD患者完成随访并纳入此次分析。96.3%(284/295)的研究对象为轻度COPD患者。随访期间,11.1%(33/295)的患者报告发生了急性加重。多元负二项回归的结果显示,随着BMI的升高,急性加重发生风险随之下降(IRR=0.85,95%CI:0.73~0.98),患者处于超重组(BMI≥25.0 kg/m^(2):IRR=0.36,95%CI:0.13~0.91)或BMI处于中等程度(T_(2)vs.T_(1),IRR=0.31,95%CI:0.11~0.77)相比于正常或低BMI组的患者而言,其急性加重发生风险更低。BMI与急性加重风险之间存在线性关系。结论轻中度社区COPD患者急性加重的风险会随着BMI的升高而下降,处于超重状态或可对COPD患者的急性加重发生风险具有保护作用。Objective BMI may play a protective role in reducing the mortality rate of patients with chronic obstructive pulmonary disease(COPD),but its effect on acute exacerbation of COPD remain unclear.Methods Subjects were selected from the COPD patients registration system established in 2014 in Pudong new district,Shanghai.COPD patients from 8 communities were selected by cluster sampling and follow up was conducted prospectively for 18 months.Basic information and BMI were obtained from baseline survey,and acute exacerbations were collected during follow-up.The association between BMI and risk of acute exacerbation was evaluated by using multiple negative binomial regression.Results Among 328 community COPD patients,295 who completed the follow up were included in the analysis,in whom 96.3%(284/295)were mild COPD patients.During the follow-up,11.1%(33/295)of the patients reported acute exacerbation.The results of multiple negative binomial regression suggested that,the risk for acute exacerbation decreased with the increase of BMI(IRR=0.85,95%CI:0.73-0.98),overweight patients with BMI≥25.0 kg/m^(2)(IRR=0.36,95%CI:0.13-0.91)or moderate BMI(T_(2) vs.T_(1),IRR=0.31,95%CI:0.11-0.77)had lower risk for acute exacerbation compared with the patients with normal or low BMI.BMI had a linear correlation with the risk of acute exacerbation.Conclusion The risk for acute exacerbation in patients with mild or moderate COPD in communities decreased with the increase of BMI,and being overweight might be a protective factor for the acute exacerbation of COPD.

关 键 词：慢性阻塞性肺疾病 体质指数 急性加重 队列研究 

分 类 号：R563.9[医药卫生—呼吸系统]