慢性阻塞性肺疾病患者身体成分与心肺运动能力的相关性研究  

Correlation between Body Composition and Cardiopulmonary Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease

作　　者：于春艳 董芬 雷洁萍 杨汀 夏金根 曲木诗玮 杨天祎 李晓盼 YU Chunyan;DONG Fen;LEI Jieping;YANG Ting;XIA Jingen;QUMU Shiwei;YANG Tianyi;LI Xiaopan(Department of Pulmonary and Critical Care Medicine,Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100191,China;National Center for Respiratory Medicine/State Key Laboratory of Respiratory Health and Multimorbidity/National Clinical Research Center for Respiratory Diseases/Institute of Respiratory Medicine,Chinese Academy of Medical Sciences/Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;National Center for Respiratory Medicine/State Key Laboratory of Respiratory Health and Multimorbidity/National Clinical Research Center for Respiratory Diseases/Institute of Respiratory Medicine,Chinese Academy of Medical Sciences/Research Programs and Data Management Department,Center of Respiratory Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Rehabilitation Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京大学中日友好临床医学院呼吸与危重症医学科,北京市100191 [2]国家呼吸医学中心、呼吸和共病全国重点实验室、国家呼吸系统疾病临床研究中心、中国医学科学院呼吸病学研究院、中日友好医院呼吸中心呼吸与危重症医学科,北京市100029 [3]国家呼吸医学中心、呼吸和共病全国重点实验室、国家呼吸系统疾病临床研究中心、中国医学科学院呼吸病学研究院、中日友好医院呼吸中心研究项目及数据管理部,北京市100029 [4]中日友好医院康复医学科,北京市100029

出　　处：《中国全科医学》2024年第29期3629-3634,共6页Chinese General Practice

基　　金：中国医学科学院医学与健康科技创新工程(2021-12M-1-049)。

摘　　要：背景心肺运动试验(CPET)对于评估慢性阻塞性肺疾病(COPD)患者最大运动能力以及制订康复处方有着至关重要的作用。有研究表明,身体成分与CPET结果相关。CPET操作复杂、耗时长、禁忌证较多且风险大,一些COPD患者无法完成,而身体成分分析操作简单快捷。目的探讨COPD患者的身体成分与CPET的相关性,为不能完成CPET的COPD患者预测最大运动能力、制订康复处方、合理营养支持提供依据。方法回顾性选取2021年7月—2022年3月于中日友好医院进行身体成分检测和CPET检测的稳定期COPD患者77例,依次进行身体成分测定和负荷连续递增的CPET,评估身体成分和CPET结果的关系。结果77例符合要求的稳定期COPD患者均完成了身体成分测定和CPET。相关性分析结果显示,体脂率(BFP)与最高运动状态时代谢当量(peakMETs)呈负相关(P<0.01);骨骼肌质量指数(SMI)与最高运动状态时摄氧量(peakVO_(2))、最高运动状态时运动负荷(peakLoad)、最大分钟通气量(peakVE)、最高运动状态时心率(peakHR)、最高运动状态时氧脉搏(peakO_(2)pulse)、摄氧效率斜率(OUES)呈正相关(P<0.01);去脂体质量指数(FFMI)与peakVO_(2)、peakLoad、peakVE、peakO_(2)pulse、OUES呈正相关(P<0.01)。多元线性回归分析结果显示,SMI、FFMI与COPD患者peakLoad、peakVE、peakO_(2)pulse、OUES呈独立正相关(P<0.05);BFP与COPD患者peakMETs呈独立负相关(P<0.05)。其中在因变量为peakLoad、peakVE、peakO_(2)pulse、OUES的多元线性回归分析中,SMI的β值高于FFMI。结论肌肉含量与COPD患者的运动能力呈正相关,身体成分测定结果可以作为COPD患者运动能力预测、指导康复运动、合理营养支持治疗的重要标准。Background Cardiopulmonary exercise testing(CPET)is essential for assessing the maximal exercise capacity of patients with chronic obstructive pulmonary disease(COPD)and for developing rehabilitation prescriptions.Body composition has been shown to be associated with CPET results,which is complex,time-consuming,contraindicated,and risky,and cannot be performed in some COPD patients,whereas body composition analysis is simple and fast.Objective This paper focuses on the correlation between body composition and CPET in patients with COPD,and provides a basis for predicting maximal exercise capacity,formulating rehabilitation prescriptions,and rational nutritional support for patients with COPD who are unable to complete cardiopulmonary exercise testing.Methods Stable COPD patients were enrolled in the outpatient respiratory clinic of China-Japan Friendship Hospital between July 2021 and March 2022,and were sequentially subjected to body composition measurements and CPET with continuous incremental loading,and the test results were analyzed to assess the relationship between body composition and CPET results,and to analyze the value of the body composition indexes in predicting the results of CPET.Results Seventy-seven eligible patients with stable COPD completed body composition measurement and exercise cardiopulmonary exercise testing.Correlation analysis showed that body fat percentage(BFP)was negatively correlated with peak metabolic equivalents(peakMETs)(P<0.01);skeletal muscle mass index(SMI)was positively correlated with peak oxygen uptake(peakVO_(2)),peak load,peak ventilation volume(peakVE),maximum heart rate(peakHR),peak oxygen pulse(peakO_(2)pulse),and oxygen uptake efficiency slope(OUES)at the highest exercise state were positively correlated(P<0.01);and the fat free mass index(FFMI)was positively correlated with peakVO_(2),peakLoad,peakVE,peakO_(2)pulse,and OUES(P<0.01).The results of multivariable linear regression analysis showed that SMI and FFMI were independently and positively correlated with peak

关 键 词：慢性阻塞性肺疾病 心肺运动试验 身体成分 康复 多元线性回归 

分 类 号：R563.9[医药卫生—呼吸系统]