肺康复对 GOLD 分期 II 至 IV 期 COPD 患者外周肌纤维重塑的影响。
Effect of pulmonary rehabilitation on peripheral muscle fiber remodeling in patients with COPD in GOLD stages II to IV.
机构信息
Department of Critical Care Medicine, Pulmonary Rehabilitation Center, Evangelismos Hospital, Athens, Greece; Department of Physical Education and Sport Sciences, Athens, Greece.
Department of Physical Education and Sport Sciences, Athens, Greece; 1st Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
出版信息
Chest. 2011 Sep;140(3):744-752. doi: 10.1378/chest.10-3058. Epub 2011 Apr 14.
BACKGROUND
In most patients with COPD, rehabilitative exercise training partially reverses the morphologic and structural abnormalities of peripheral muscle fibers. However, whether the degree of improvement in muscle fiber morphology and typology with exercise training varies depending on disease severity remains unknown.
METHODS
Forty-six clinically stable patients with COPD classified by GOLD (Global Initiative for Obstructive Lung Disease) as stage II (n = 14), III (n = 18), and IV (n = 14) completed a 10-week comprehensive pulmonary rehabilitation program consisting of high-intensity exercise three times weekly.
RESULTS
At baseline, muscle fiber mean cross-sectional area and capillary density did not significantly differ between patients with COPD and healthy control subjects, whereas muscle fiber type I and II proportion was respectively lower (P < .001) and higher (P < .002) in patients with GOLD stage IV compared with healthy subjects and patients with GOLD stages II and III. Exercise training improved, to a comparable degree, functional capacity and the St. George Respiratory Questionnaire health-related quality of life score across all three GOLD stages. Vastus lateralis muscle fiber mean cross-sectional area was increased (P < .001) in all patient groups (stage II: from 4,507 ± 280 μm² to 5,091 ± 271 μm² [14% ± 3%]; stage III: from 3,753 ± 258 μm² to 4,212 ± 268 μm² [14% ± 3%]; stage IV: from 3,961 ± 266 μm² to 4,551 ± 262 μm² [17% ± 5%]), whereas all groups exhibited a comparable reduction (P < .001) in type IIb fiber proportion (stage II: by 6% ± 2%; stage III: by 6% ± 1%; stage IV: by 7% ± 1%) and an increase (P < .001) in capillary to fiber ratio (stage II: from 1.48 ± 0.10 to 1.81 ± 0.10 [23% ± 5%]; stage III: from 1.29 ± 0.06 to 1.56 ± 0.09 [21% ± 5%]; stage IV: from 1.43 ± 0.10 to 1.71 ± 0.13 [18 ± 3%]). The magnitude of changes in the aforementioned variables did not differ across GOLD stages.
CONCLUSIONS
Functional capacity and morphologic and typologic adaptations to rehabilitation in peripheral muscle fibers were similar across GOLD stages II to IV. Pulmonary rehabilitation should be implemented in patients at all COPD stages.
背景
在大多数 COPD 患者中，康复运动训练部分逆转了外周肌纤维的形态和结构异常。然而，运动训练对肌纤维形态和类型的改善程度是否因疾病严重程度而异尚不清楚。
方法
46 例临床稳定的 COPD 患者根据 GOLD（全球倡议阻塞性肺疾病）分为 II 期（n=14）、III 期（n=18）和 IV 期（n=14），完成了为期 10 周的综合肺康复计划，包括每周 3 次的高强度运动。
结果
在基线时，COPD 患者的肌纤维平均横截面积和毛细血管密度与健康对照组无显著差异，而 IV 期 GOLD 患者的肌纤维 I 型和 II 型比例分别较低（P<.001）和较高（P<.002）与健康受试者和 GOLD 分期 II 和 III 期患者相比。在所有三个 GOLD 分期中，运动训练都以相当的程度改善了功能能力和圣乔治呼吸问卷健康相关生活质量评分。所有患者组的股外侧肌纤维平均横截面积均增加（P<.001）（II 期：从 4507±280μm²增加到 5091±271μm²[14%±3%]；III 期：从 3753±258μm²增加到 4212±268μm²[14%±3%]；IV 期：从 3961±266μm²增加到 4551±262μm²[17%±5%]），而所有组的 IIb 型纤维比例（P<.001）都有类似的降低（II 期：降低 6%±2%；III 期：降低 6%±1%；IV 期：降低 7%±1%）和毛细血管与纤维比（P<.001）的增加（II 期：从 1.48±0.10 增加到 1.81±0.10[23%±5%]；III 期：从 1.29±0.06 增加到 1.56±0.09[21%±5%]；IV 期：从 1.43±0.10 增加到 1.71±0.13[18%±3%]）。上述变量的变化幅度在 GOLD 各期之间没有差异。
结论
在 GOLD 分期 II 至 IV 期，外周肌纤维的功能能力和形态学及类型学适应康复治疗相似。肺康复应在所有 COPD 阶段的患者中实施。
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