Budweiser S, Meyer K, Jörres R A, Heinemann F, Wild P J, Pfeifer M
Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany.
Eur J Clin Nutr. 2008 Mar;62(3):436-43. doi: 10.1038/sj.ejcn.1602708. Epub 2007 Mar 7.
While malnutrition, especially fat-free mass index (FFMI), is a predictor for mortality in chronic obstructive pulmonary disease (COPD), less information on prevalence and mechanisms is available in patients with chronic respiratory failure (CRF) due to restrictive thoracic diseases (RTD).
Cross-sectional study of patients consecutively admitted to an in-patient primary pulmonary centre.
One hundred and thirty-two patients (30% RTD; 70% COPD) with CRF and intermittent non-invasive positive pressure ventilation.
Malnutrition was quantified by bioelectrical impedance analysis or body mass index (BMI), and its relationship to laboratory, lung function, inspiratory muscle and blood gas parameters and 6-min walking distance (6-MWD) was assessed.
Malnutrition in terms of BMI<20 kg/m(2) occurred in 16.1% of patients with COPD but none of those with RTD. FFMI<17.4 (<15.0 in female patients) kg/m(2) was found in 35.4 and 30.7%, respectively. FFMI was correlated with airway obstruction (sR(aw), r = -0.50; FEV(1)/VC, r = -0.28; P< or = 0.01 each) and lung hyperinflation (intrathoracic gas volume, r = -0.41; total lung capacity (TLC), r = -0.50; P< or = 0.001 each) in COPD, and with lung restriction in RTD (TLC, r=0.40; P=0.011). Furthermore, malnourished patients showed a higher inspiratory load (P (0.1)) and reduced 6-MWD in both groups. In COPD, only hyperinflation and P (0.1) were independently related to FFMI.
Malnutrition as indicated by low FFMI was similarly prevalent in patients with CRF and COPD or RTD, but inadequately represented by BMI. The correlations between lung function impairments specific for the disease and FFMI emphasized the link between malnutrition and respiratory mechanical load irrespective of its aetiology.
虽然营养不良，尤其是去脂体重指数（FFMI），是慢性阻塞性肺疾病（COPD）患者死亡率的一个预测指标，但关于因限制性胸疾病（RTD）导致慢性呼吸衰竭（CRF）患者的患病率及机制的信息较少。
对连续入住一家住院初级肺科中心的患者进行横断面研究。
132例患有CRF且需间歇性无创正压通气的患者（30%为RTD；70%为COPD）。
通过生物电阻抗分析或体重指数（BMI）对营养不良进行量化，并评估其与实验室检查、肺功能、吸气肌及血气参数以及6分钟步行距离（6-MWD）的关系。
BMI<20 kg/m²的营养不良情况在COPD患者中占16.1%，而RTD患者中无一例出现。FFMI<17.4 kg/m²（女性患者<15.0 kg/m²）在COPD和RTD患者中分别占35.4%和30.7%。在COPD患者中，FFMI与气道阻塞（sR(aw)，r = -0.50；FEV(1)/VC，r = -0.28；P均≤0.01）及肺过度充气（胸腔内气体容积，r = -0.41；肺总量（TLC），r = -0.50；P均≤0.001）相关，在RTD患者中与肺限制性相关（TLC，r = 0.40；P = 0.011）。此外，两组营养不良患者均表现出较高的吸气负荷（P(0.1)）及缩短的6-MWD。在COPD患者中，仅肺过度充气和P(0.1)与FFMI独立相关。
低FFMI所提示的营养不良在CRF合并COPD或RTD患者中同样普遍，但BMI未能充分体现。疾病特异性肺功能损害与FFMI之间的相关性强调了营养不良与呼吸机械负荷之间的联系，而不论其病因如何。
