长期氧疗治疗慢性阻塞性肺疾病患者营养消耗的预后价值：来自ANTADIR观测站的数据

Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory.

作者信息

Chailleux Edmond, Laaban Jean-Pierre, Veale Dan

机构信息

ANTADIR Observatory, Paris, France.

出版信息

Chest. 2003 May;123(5):1460-6. doi: 10.1378/chest.123.5.1460.

DOI:10.1378/chest.123.5.1460

PMID:12740261

Abstract

BACKGROUND

An association between weight depletion and mortality has been demonstrated in patients with COPD, but the prognostic influence of malnutrition has not been evaluated in patients with the most severe COPD treated with home long-term oxygen therapy (LTOT).

STUDY OBJECTIVE

To analyze the prognostic value of nutritional depletion in patients with COPD receiving LTOT with respect to survival and hospitalization rate.

DESIGN

Analysis of a national database (Observatory of Association Nationale pour le Traitement a Domicile de l'Insuffisance Respiratoire Chronique [ANTADIR]).

SETTING

The national nonprofit network for home treatment of patients with chronic respiratory insufficiency (ANTADIR) founded in France in the 1980s.

PATIENTS

A total of 4,088 patients with a diagnosis of chronic bronchitis or emphysema, FEV(1)/vital capacity ratio < 60%, PaO(2) < 8 kPa, and treatment with LTOT between 1984 and 1993.

MEASUREMENTS AND RESULTS

The prevalence of malnutrition, as defined by a body mass index (BMI) < 20, was 23% in men and 30% in women. BMI was significantly correlated with FEV(1) and FEV(1)/VC. The mean follow-up duration was 7.5 years. The 5-year survival rates were 24%, 34%, 44%, and 59%, respectively, for patients with BMIs < 20, 20 to 24, 25 to 29, and > or = 30. Multivariate analysis using the Cox model demonstrated that the effect of BMI on survival was independent of age, FEV(1), PaO(2), and sex. Lower BMI was the most powerful predictor of duration and rate of hospitalization, independently of blood gas levels and respiratory function. The mean (+/- SD) annual time spent in the hospital was 29.6 +/- 40.4 days for patients with a BMI < 20 vs 17.5 +/- 30.1 days for patients with a BMI > 30.

CONCLUSION

This study showed that nutritional depletion is an independent risk factor for mortality and hospitalization in patients with COPD receiving LTOT. The best prognosis was observed in overweight and obese patients.

摘要

背景

慢性阻塞性肺疾病（COPD）患者体重减轻与死亡率之间的关联已得到证实，但对于接受家庭长期氧疗（LTOT）的最严重COPD患者，营养不良的预后影响尚未得到评估。

研究目的

分析接受LTOT的COPD患者营养消耗对生存和住院率的预后价值。

设计

对国家数据库（法国全国慢性呼吸功能不全家庭治疗协会观察站[ANTADIR]）进行分析。

设置

20世纪80年代在法国建立的全国性慢性呼吸功能不全患者家庭治疗非营利网络（ANTADIR）。

患者

共有4088例诊断为慢性支气管炎或肺气肿、第1秒用力呼气容积（FEV₁）/肺活量比值<60%、动脉血氧分压（PaO₂）<8kPa且在1984年至1993年间接受LTOT治疗的患者。

测量与结果

根据体重指数（BMI）<20定义的营养不良患病率，男性为23%，女性为30%。BMI与FEV₁及FEV₁/肺活量显著相关。平均随访时间为7.5年。BMI<20、20至24、25至29以及≥30的患者5年生存率分别为24%、34%、44%和59%。使用Cox模型进行的多变量分析表明，BMI对生存的影响独立于年龄、FEV₁、PaO₂和性别。较低的BMI是住院时间和住院率的最有力预测因素，独立于血气水平和呼吸功能。BMI<20的患者平均（±标准差）每年住院时间为29.6±40.4天，而BMI>30的患者为17.5±30.1天。