Gosker Harry R, Zeegers Maurice P, Wouters Emiel F M, Schols Annemie M W J
Department of Respiratory Medicine, NUTRIM, Maastricht University, P O Box 616, 6200 MD Maastricht, The Netherlands.
Thorax. 2007 Nov;62(11):944-9. doi: 10.1136/thx.2007.078980. Epub 2007 May 25.
Skeletal muscle dysfunction is a common feature in chronic obstructive pulmonary disease (COPD) which is associated with intrinsic muscular abnormalities. One of the most consistently reported alterations is a shift from fibre type I to II in the vastus lateralis of these patients. Surprisingly, the relationship between this shift and the severity and phenotype of COPD remains unclear. A study was conducted to determine whether vastus lateralis muscle fibre type proportions are associated with COPD disease severity and to provide reference values for the proportions of fibre types in the vastus lateralis in COPD.
A systematic review and a meta-analysis were conducted in which muscle fibre type data and markers of disease severity were collected from the literature.
The forced expiratory volume in 1 s (FEV(1)), the ratio of FEV(1) to forced vital capacity (FVC) and body mass index were positively associated with the proportion of type I fibres in COPD. A proportion of 51% for vastus lateralis fibre type I and 13% for fibre type IIX were calculated from the combined data as normal values for patients with typical GOLD stage 3-4 COPD aged 60-70 years. Based on these reference values, a proportion of fibre type I <27% and of fibre type IIX >29% were defined as pathologically abnormal.
This review sheds new light on the relationship between skeletal muscle abnormalities and important hallmarks of the disease in severe COPD, and identifies absence of data in GOLD stages 1-2. This review also provides reference values on fibre type composition for diagnostic purposes in COPD.
骨骼肌功能障碍是慢性阻塞性肺疾病（COPD）的常见特征，与内在肌肉异常有关。最常报道的改变之一是这些患者股外侧肌中I型纤维向II型纤维的转变。令人惊讶的是，这种转变与COPD的严重程度和表型之间的关系仍不清楚。进行了一项研究以确定股外侧肌纤维类型比例是否与COPD疾病严重程度相关，并为COPD患者股外侧肌纤维类型比例提供参考值。
进行了一项系统评价和荟萃分析，从文献中收集肌肉纤维类型数据和疾病严重程度标志物。
1秒用力呼气容积（FEV(1)）、FEV(1)与用力肺活量（FVC）的比值以及体重指数与COPD患者I型纤维比例呈正相关。根据合并数据计算出，对于60 - 70岁典型GOLD 3 - 4期COPD患者，股外侧肌I型纤维比例的正常值为51%，IIX型纤维比例为13%。基于这些参考值，将I型纤维比例<27%和IIX型纤维比例>29%定义为病理异常。
本综述为严重COPD中骨骼肌异常与疾病重要特征之间的关系提供了新的见解，并指出GOLD 1 - 2期缺乏相关数据。本综述还提供了纤维类型组成的参考值，用于COPD的诊断。
