慢性阻塞性肺疾病中的厌食症——与恶病质和激素紊乱的关联。

Anorexia in chronic obstructive pulmonary disease--association to cachexia and hormonal derangement.

作者信息

Koehler Friedrich, Doehner Wolfram, Hoernig Soeren, Witt Christian, Anker Stefan D, John Matthias

机构信息

Department of Cardiology, Charité University Hospital, Campus Mitte, Berlin, Germany.

出版信息

Int J Cardiol. 2007 Jun 25;119(1):83-9. doi: 10.1016/j.ijcard.2006.07.088. Epub 2006 Oct 24.

DOI:10.1016/j.ijcard.2006.07.088

PMID:17064790

Abstract

BACKGROUND

In patients with chronic obstructive pulmonary disease (COPD) weight loss frequently occurs that may ultimately lead to cachexia as a serious co-morbidity, indicating severely impaired functional capacity, health status and increased mortality. Increased energy expenditure due to mechanic and metabolic inefficiency and systemic inflammation are determinants of a hypermetabolic state that is not balanced by dietary intake. Anorexia may importantly contribute to weight loss in COPD, however, the association between immune and hormonal derangement and altered appetite has not been studied in detail.

AIM

The aim of the present study was to investigate whether anorexia in COPD is related to inflammation and hormonal derangement in association to weight loss.

METHODS

We prospectively enrolled 103 consecutive patients with COPD (age 59.8+/-1.3 years, 35% female, mean FEV1 38.3+/-1.7%) in comparison to healthy controls of similar age (n=15).

RESULTS

In 34 patients (33%) cachexia was diagnosed (weight loss >7.5%, BMI < or = 24 kg/m2). Cachectic COPD patients had lower BMI (19.0+/-0.5 vs 25.6+/-0.7 kg/m2) and impaired lung function (FEV1 31+/-2% vs 42+/-2%, FVC 51+/-3 vs 59+/-3%, both p<0.001). Inflammatory immune activation (IL-6 and IL-6/IL-10 ratio) was significantly higher in cachectic COPD patients. Analysis of the extent of anorexia (visual analogue scale) revealed that cachectic COPD patients had significantly decreased subjective desire to eat compared to non-cachectic patients (3.5+/-0.3 vs 6.3+/-0.2, p<0.001). Patients with COPD and cachexia showed evidence of acquired GH resistance (decreased IGF-1/GH ratio) and insulin resistance (HOMA). Anorexia showed a direct correlation with the IGF-1/GH ratio (r=0.34, p<0.05) and was further related to BMI and % weight loss (both p<0.001).

CONCLUSION

In COPD anorexia relates to hormonal derangement and inflammatory immune activation. Anorexia contributes to development of cachexia. The concept of appetite stimulating therapy emerges as a novel therapeutic option in cachectic COPD patients.

摘要

背景

慢性阻塞性肺疾病（COPD）患者经常出现体重减轻，最终可能导致恶病质，这是一种严重的合并症，表明功能能力严重受损、健康状况不佳且死亡率增加。机械和代谢效率低下以及全身炎症导致的能量消耗增加是一种高代谢状态的决定因素，而饮食摄入无法平衡这种状态。厌食可能是COPD患者体重减轻的重要原因，然而，免疫和激素紊乱与食欲改变之间的关联尚未得到详细研究。

目的

本研究的目的是调查COPD患者的厌食是否与炎症、激素紊乱以及体重减轻有关。

方法

我们前瞻性地纳入了103例连续的COPD患者（年龄59.8±1.3岁，女性占35%，平均第一秒用力呼气容积[FEV1]为38.3±1.7%），并与年龄相仿的健康对照者（n = 15）进行比较。

结果

34例患者（33%）被诊断为恶病质（体重减轻>7.5%，体重指数[BMI]≤24 kg/m²）。恶病质的COPD患者BMI较低（19.0±0.5 vs 25.6±0.7 kg/m²），肺功能受损（FEV1为31±2% vs 42±2%，用力肺活量[FVC]为51±3 vs 59±3%，两者p<0.001）。恶病质的COPD患者炎症免疫激活（白细胞介素-6[IL-6]和IL-6/白细胞介素-10[IL-10]比值）显著更高。对厌食程度（视觉模拟评分）的分析显示，与非恶病质患者相比，恶病质的COPD患者主观进食欲望显著降低（3.5±0.3 vs 6.3±0.2，p<0.001）。患有COPD和恶病质的患者表现出获得性生长激素抵抗（胰岛素样生长因子-1[IGF-1]/生长激素[GH]比值降低）和胰岛素抵抗（稳态模型评估）的证据。厌食与IGF-1/GH比值呈直接相关（r = 0.34，p<0.05），并与BMI和体重减轻百分比进一步相关（两者p<0.001）。