腹部肥胖对COPD急性加重的影响  

Effect of abdominal obesity on acute exacerbation in patients with chronic obstructive pulmonary disease(COPD)

作　　者：李媛媛[1] 李翔鹏 李争[3] 荆晶[3] 徐丹[3] 戴江红[1] LI Yuanyuan;LI Xiangpeng;LI Zheng;JING Jing;XU Dan;DAI Jianghong(School of Public Health,Urumqi 830017,China;The Fourth Clinical College,the Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830000,China;Department of Respiratory Medicine,the Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学公共卫生学院,乌鲁木齐830017 [2]新疆医科大学第四临床医学院,乌鲁木齐830000 [3]新疆医科大学附属中医医院呼吸科,乌鲁木齐830000

出　　处：《新疆医科大学学报》2024年第5期638-643,共6页Journal of Xinjiang Medical University

基　　金：国家自然科学基金项目(82360662,82160640);科技创新团队“天山创新团队”项目(2022TSYCTD0013)。

摘　　要：目的探讨腹部肥胖相关指标对慢性阻塞性肺疾病(COPD)患者急性加重的影响。方法对“新疆多民族自然人群队列建设及健康随访研究”招募的和田墨玉县常住居民经肺功能检测诊断为COPD的患者,进行问卷及常规检查测量腰围,体成分检测内脏脂肪等级,计算腰高比、体重调整腰围指数(WWI),随访患者至少1年急性加重住院情况。以急性加重住院为结局分析腹部肥胖相关指标对COPD急性加重的影响,并比较不同腹部肥胖指标对COPD急性加重的预测价值。结果631名COPD患者经过随访,报告了186例COPD急性加重住院病例。整个随访期间,COPD急性加重和无急性加重患者在年龄、肺结核疾病史、吸烟、二手烟、烹饪和取暖燃料、慢阻肺患者评价评分(CAT评分)等方面的比较差异有统计学意义(均P<0.05)。单因素及模型1和2显示,腰围、腰高比、WWI、内脏脂肪等级均对COPD急性加重有影响,指标每增加一个单位急性加重均有增加;腰高比及内脏脂肪等级对COPD急性加重影响的结果较稳定,多重调整后腰高比OR=1.304(1.010~1.683),内脏脂肪等级OR=1.912(1.122~3.257)。腹部肥胖相关指标对COPD急性加重均有预测价值,其中WWI的曲线下面积最大,为0.614。结论腹部肥胖指标腰高比、WWI、内脏脂肪等级是COPD急性加重的危险因素,COPD的防控应考虑减少腹部肥胖的干预策略。Objective To explore the impact of abdominal obesity on acute exacerbations of chronic obstructive pulmonary disease(COPD).Methods Resident of Moyu County,Hotan,recruited on the basis of“Xinjiang multi-ethnic natural population cohort”.Pulmonary function tests were performed to confirm COPD.All subjects were subjected to questionnaire survey and waist measurement,body composition testing for visceral fat level,calculation of waist-to-height ratio,and weight-adjusted waist index(WWI).The patients were followed up for at least 1 year to assess the occurrence of acute exacerbations requiring hospitalization.The impact of abdominal obesity-related indicators on acute exacerbations was analyzed,and the predictive value of different abdominal obesity indicators on COPD acute exacerbations was compared.Results After follow-up of 631 patients with COPD,186 hospitalized cases of acute exacerbation of COPD were reported.Throughout the follow-up period,there were statistically significant differences in terms of age,history of pulmonary tuberculosis,smoking,secondhand smoke exposure,cooking and heating fuels and CAT scores between the patients with and without acute exacerbations of COPD(all P<0.05).Single factor and models 1 and 2 demonstrated that waist circumference,waist-to-height ratio,WWI,and visceral fat had impacts on COPD acute exacerbations.An increase in the obesity index corresponded to an increase in the risk of COPD acute exacerbations.The waist-to-height ratio and visceral fat level's impact on COPD acute exacerbations were relatively stable.After multiple adjustments,the OR of waist-to-height ratio was 1.304(1.010~1.683),and the OR of visceral fat level was 1.912(1.122~3.257).Abdominal obesity-related indicators had predictive value for COPD acute exacerbations,with WWI having the largest area under the curve 0.614.Conclusion Abdominal obesity indicators such as waist-to-height ratio,WWI and visceral fat level are risk factors for COPD acute exacerbations,and intervention strategies to reduce abdominal o

关 键 词：COPD 急性加重 腹部肥胖 内脏脂肪 

分 类 号：R181.37[医药卫生—流行病学]