Department of Chest Diseases, Ege University School of Medicine, Izmir, Turkey.
Respirology. 2013 Apr;18(3):495-500. doi: 10.1111/resp.12019.
Nutritional depletion in chronic obstructive pulmonary disease (COPD) adversely affects health status and mortality. We aimed to evaluate the effects of nutritional supplementation (NS) with pulmonary rehabilitation (PR) on body composition, mid-thigh cross-sectional area (CSA), dyspnoea, exercise capacity, health-related quality of life, anxiety and depression in advanced COPD patients.
Forty-six patients were randomized to PR and nutritional support (PRNS), PR or the control group. Dyspnoea was measured with Medical Research Council and BORG scales. Exercise capacity was measured through 6-min walk test and shuttle tests; health-related quality of life was assessed with St. George's Respiratory Questionnaire. Psychological status was measured with Hospital Anxiety and Depression Scale. Body weight and body mass indexes (BMI) were also evaluated. Fat-free mass was measured through bioelectrical impedance analyser. The CSA of quadriceps was calculated in mid-level of the thigh with magnetic resonance imaging.
Dyspnoea and total scores of St. George's Respiratory Questionnaire improved in both groups (P < 0.05). Six-minute walk test and incremental shuttle walk test distances in PRNS and PR patients increased significantly as (62.6 ± 42.4 m, 43.3 ± 59.2 m, both P = 0.001; and 63.3 ± 70.1 m and 69.3 ± 69.7 m, both P = 0.001). Although anxiety improved in both groups (P < 0.05), there was no change in depression. Body weight, BMI and fat-free mass index (FFMI) (1.1 ± 0.9 kg, 0.2 ± 1.4 kg/m(2) and 0.6 ± 0.5 kg/m(2), P < 0.05) in PRNS, whereas body weight and FFMI (0.6 ± 0.7 kg, 0.1 ± 0.6 kg/m(2) P < 0.05) increased in PR after the intervention. There was a significant increase in mid-thigh CSA (2.5 ± 4.1 cm(2)) only in PRNS (P = 0.04).
The combination of NS with PR resulted in improvements particularly in lean body mass and mid-thigh CSA. This study suggests combining NS with PR in reversing weight loss and muscle wasting in COPD.
慢性阻塞性肺疾病（COPD）患者的营养消耗会对其健康状况和死亡率产生不利影响。本研究旨在评估营养补充（NS）联合肺康复（PR）对晚期 COPD 患者的身体成分、大腿中段横截面积（CSA）、呼吸困难、运动能力、健康相关生活质量、焦虑和抑郁的影响。
46 名患者被随机分为 PR 和营养支持（PRNS）组、PR 组或对照组。呼吸困难采用英国医学研究理事会（MRC）和 Borg 量表进行评估。运动能力通过 6 分钟步行试验和穿梭试验进行测量；健康相关生活质量采用圣乔治呼吸问卷（SGRQ）进行评估。心理状态采用医院焦虑抑郁量表（HADS）进行评估。体重和体质量指数（BMI）也进行了评估。通过生物电阻抗分析器测量去脂体重。大腿中段 CSA 通过磁共振成像（MRI）进行计算。
两组患者的呼吸困难和 SGRQ 总评分均有所改善（均 P<0.05）。PRNS 和 PR 组患者的 6 分钟步行试验和递增穿梭步行试验距离均显著增加（分别为 62.6±42.4m 和 43.3±59.2m，均 P=0.001；63.3±70.1m 和 69.3±69.7m，均 P=0.001）。两组患者的焦虑均有所改善（均 P<0.05），但抑郁无变化。PRNS 组患者体重、BMI 和去脂体重指数（FFMI）（1.1±0.9kg、0.2±1.4kg/m2和 0.6±0.5kg/m2，均 P<0.05）增加，而 PR 组患者体重和 FFMI（0.6±0.7kg、0.1±0.6kg/m2，均 P<0.05）在干预后增加。仅 PRNS 组大腿中段 CSA 显著增加（2.5±4.1cm2，P=0.04）。
NS 联合 PR 可显著改善瘦体重和大腿中段 CSA。本研究提示 NS 联合 PR 可逆转 COPD 患者的体重减轻和肌肉消耗。
