Piitulainen Eeva, Areberg Johan, Lindén Mikael, Eriksson Sten, Mattsson Sören, Wollmer Per
Department of Lung Medicine, Malmö University Hospital, SE-205 02 Malmö, Sweden.
Chest. 2002 Oct;122(4):1240-6. doi: 10.1378/chest.122.4.1240.
The association between emphysema and weight loss is well known. Severe alpha(1)-antitrypsin deficiency is an important risk factor for the development of emphysema.
To study nutritional status and muscle strength in patients with severe alpha(1)-antitrypsin deficiency and emphysema.
Fifteen alpha(1)-antitrypsin-deficient patients with emphysema (7 men) and 18 healthy control subjects (9 men) were included in the study. Total body protein (TBP) was measured by in vivo neutron activation analysis of nitrogen. Lean body mass (LBM) was estimated from measurement of total body potassium. In analogy with body mass index (BMI), TBP index and LBM index were calculated as TBP/height squared and LBM/height squared, respectively. Respiratory muscle strength was studied by maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), and skeletal muscle strength by handgrip test. Plasma albumin, transthyretin, and retinol-binding protein concentrations were analyzed as biochemical markers of nutritional status.
In the alpha(1)-antitrypsin-deficient individuals, lung function test results were consistent with severe chronic airway obstruction, whereas the healthy control subjects had normal lung function. No significant differences were found in age, body weight, or BMI between the groups. TBP (p < 0.05), TBP index (p < 0.001), LBM index (p < 0.05), and plasma concentration of transthyretin (p < 0.01) were significantly lower in the patients than in the control subjects. There was a significant correlation between TBP and LBM (p < 0.001), and between TBP and body weight (p < 0.001). In the male subgroup, PImax (p < 0.05) and PEmax (p < 0.05) were significantly lower in the patients than in the control subjects. In the female subgroup, handgrip strength was significantly lower in the patients than in the control subjects (p < 0.05). Body weight was significantly correlated with handgrip test (p < 0.05) in the male patients. In the female patients, body weight was significantly correlated with PImax (p < 0.05), LBM with PEmax (p < 0.05), and LBM with handgrip test (p < 0.01).
Reduced TBP and plasma transthyretin concentration in alpha(1)-antitrypsin-deficient patients with emphysema may indicate early signs of malnutrition.
肺气肿与体重减轻之间的关联众所周知。严重的α1-抗胰蛋白酶缺乏是肺气肿发生的重要危险因素。
研究严重α1-抗胰蛋白酶缺乏合并肺气肿患者的营养状况和肌肉力量。
本研究纳入了15例α1-抗胰蛋白酶缺乏合并肺气肿的患者（7例男性）和18例健康对照者（9例男性）。通过对氮进行体内中子活化分析来测量全身蛋白质（TBP）。通过测量全身钾来估算去脂体重（LBM）。与体重指数（BMI）类似，分别计算TBP指数和LBM指数，即TBP/身高平方和LBM/身高平方。通过最大吸气压力（PImax）和最大呼气压力（PEmax）研究呼吸肌力量，通过握力测试研究骨骼肌力量。分析血浆白蛋白、转甲状腺素蛋白和视黄醇结合蛋白浓度作为营养状况的生化指标。
在α1-抗胰蛋白酶缺乏的个体中，肺功能测试结果与严重慢性气道阻塞一致，而健康对照者肺功能正常。两组之间在年龄、体重或BMI方面未发现显著差异。患者的TBP（p < 0.05）、TBP指数（p < 0.001）、LBM指数（p < 0.05）和转甲状腺素蛋白血浆浓度（p < 0.01）均显著低于对照者。TBP与LBM之间（p < 0.001）以及TBP与体重之间（p < 0.001）存在显著相关性。在男性亚组中，患者的PImax（p < 0.05）和PEmax（p < 0.05）显著低于对照者。在女性亚组中，患者的握力显著低于对照者（p < 0.05）。男性患者的体重与握力测试显著相关（p < 0.05）。在女性患者中，体重与PImax显著相关（p < 0.05），LBM与PEmax显著相关（p < 0.05），LBM与握力测试显著相关（p < 0.01）。
严重α1-抗胰蛋白酶缺乏合并肺气肿患者的TBP和血浆转甲状腺素蛋白浓度降低可能表明营养不良的早期迹象。
