Spruit M A, Gosselink R, Troosters T, Kasran A, Gayan-Ramirez G, Bogaerts P, Bouillon R, Decramer M
Respiratory Rehabilitation and Respiratory Division, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
Thorax. 2003 Sep;58(9):752-6. doi: 10.1136/thorax.58.9.752.
Chronic obstructive pulmonary disease (COPD) is often associated with peripheral muscle weakness, which is caused by several factors. Acute exacerbations may contribute, but their impact on muscle force remains unclear. Correlations between peripheral muscle force and inflammatory and anabolic markers have never been studied in COPD. The effect of an acute exacerbation on quadriceps peak torque (QPT) was therefore studied in hospitalised patients, and the aforementioned correlations were examined in hospitalised and in stable patients.
Lung function, respiratory and peripheral muscle force, and inflammatory and anabolic markers were assessed in hospitalised patients on days 3 and 8 of the hospital admission and 90 days later. The results on day 3 (n=34) were compared with those in clinically stable outpatients (n=13) and sedentary healthy elderly subjects (n=10).
Hospitalised patients had lowest mean (SD) QPT (66 (22)% predicted) and highest median (IQR) levels of systemic interleukin-8 (CXCL8, 6.1 (4.5 to 8.3) pg/ml). Insulin-like growth factor I (IGF-I) tended to be higher in healthy elderly subjects (p=0.09). QPT declined between days 3 and 8 in hospital (mean -5% predicted (95% CI -22 to 8)) and partially recovered 90 days after admission to hospital (mean 6% predicted (95% CI -1 to 23)). QPT was negatively correlated with CXCL8 and positively correlated with IGF-I and lung transfer factor in hospitalised and in stable patients.
Peripheral muscle weakness is enhanced during an acute exacerbation of COPD. CXCL8 and IGF-I may be involved in the development of peripheral muscle weakness in hospitalised and in stable patients with COPD.
慢性阻塞性肺疾病（COPD）常伴有外周肌肉无力，这是由多种因素引起的。急性加重可能起作用，但其对肌肉力量的影响尚不清楚。COPD患者外周肌肉力量与炎症和合成代谢标志物之间的相关性从未被研究过。因此，我们对住院患者急性加重对股四头肌峰值扭矩（QPT）的影响进行了研究，并对住院患者和稳定期患者的上述相关性进行了检查。
在住院患者入院第3天、第8天和90天后评估其肺功能、呼吸和外周肌肉力量以及炎症和合成代谢标志物。将第3天（n = 34）的结果与临床稳定的门诊患者（n = 13）和久坐的健康老年受试者（n = 10）的结果进行比较。
住院患者的平均（标准差）QPT最低（预测值的66（22）%），全身白细胞介素-8（CXCL8，6.1（4.5至8.3）pg/ml）的中位数（四分位间距）水平最高。健康老年受试者的胰岛素样生长因子I（IGF-I）往往更高（p = 0.09）。住院期间QPT在第3天至第8天下降（平均预测值下降5%（95%置信区间-22至8）），入院90天后部分恢复（平均预测值增加6%（95%置信区间-1至23））。住院患者和稳定期患者的QPT与CXCL8呈负相关，与IGF-I和肺转移因子呈正相关。
COPD急性加重期间外周肌肉无力加剧。CXCL8和IGF-I可能参与住院患者和稳定期COPD患者外周肌肉无力的发生发展。
