Tóth Stefan, Tkácová Ruzena, Matula Pavol, Stubna Ján
Department of Tuberculosis and Respiratory Medicine, Faculty of Medicine, P J Safárik University and L Pasteur Teaching Hospital, Cancer Institute, Kosice, Slovakia.
Wien Klin Wochenschr. 2004 Sep 30;116(17-18):617-21. doi: 10.1007/s00508-004-0226-6.
An association between malnutrition, weight loss and mortality has been demonstrated in patients with chronic obstructive pulmonary disease (COPD), but the prognostic influence of low body-mass index (BMI) and plasma concentrations of albumin and cholesterol is less clear in patients with chronic respiratory insufficiency treated with domiciliary long-term oxygen therapy (LTOT). We therefore analysed the prognostic value of BMI, plasma albumin and cholesterol concentrations in patients receiving LTOT.
From 1996 to 2001, LTOT was initiated in 255 patients. Analysis of the impact of nutritional status on survival was confined to a study group of 108 patients in whom the main outcomes, i.e. BMI, plasma cholesterol and albumin, were measured. Standard laboratory methods were used in the biochemical analyses. Pulmonary function was assessed with bodyplethysmography.
63 patients (58.3%) survived for two years post-initiation of LTOT and 45 patients (41.7%) did not. There were no differences between these two groups in pulmonary function tests and arterial blood gases at the start of LTOT. Overall, 10.2% of the study population were underweight, defined as BMI <20 kg/m2. Compared with patients who survived two years of LTOT, those who did not survive were older (69.3+/-0.9 versus 64.7+/-1.2 years, p<0.01), had significantly lower BMI (24.5+/-0.7 versus 26.5+/-0.7 kg/m2, p < 0.05), lower plasma cholesterol (4.61+/-0.19 versus 5.22+/-0.13 mmol/l, p<0.01) and lower plasma albumin concentrations (41.4+/-0.4 versus 42.8+/-0.4 g/l, p <0.05). Logistic regression analysis revealed that, in addition to age (p < 0.01), both BMI (p < 0.05) and cholesterol (p < 0.05) significantly affected the 2-year survival.
This study suggests that nutritional status is closely linked with prognosis in patients with chronic respiratory insufficiency treated with domiciliary LTOT: low BMI, low plasma cholesterol and low albumin are related to worse 2-year survival in such patients.
慢性阻塞性肺疾病（COPD）患者中，营养不良、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）的慢性呼吸功能不全患者，低体重指数（BMI）以及血浆白蛋白和胆固醇浓度对预后的影响尚不清楚。因此，我们分析了接受LTOT患者的BMI、血浆白蛋白和胆固醇浓度的预后价值。
1996年至2001年，255例患者开始接受LTOT。营养状况对生存影响的分析仅限于108例患者的研究组，这些患者测量了主要指标，即BMI、血浆胆固醇和白蛋白。生化分析采用标准实验室方法。用体容积描记法评估肺功能。
LTOT开始后，63例患者（58.3%）存活，45例患者（41.7%）未存活。LTOT开始时，这两组患者的肺功能测试和动脉血气分析没有差异。总体而言，10.2%的研究人群体重过低，定义为BMI<20kg/m²。与LTOT存活两年的患者相比，未存活的患者年龄更大（69.3±0.9岁对64.7±1.2岁，p<0.01），BMI显著更低（24.5±0.7对26.5±0.7kg/m²，p<0.05），血浆胆固醇更低（4.61±0.19对5.22±0.13mmol/L，p<0.01），血浆白蛋白浓度更低（41.4±0.4对42.8±0.4g/L，p<0.05）。逻辑回归分析显示，除年龄外（p<0.01），BMI（p<0.05）和胆固醇（p<0.05）均显著影响2年生存率。
本研究表明，营养状况与接受家庭LTOT治疗的慢性呼吸功能不全患者的预后密切相关：低BMI、低血浆胆固醇和低白蛋白与这类患者较差的2年生存率相关。
