NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, England.
Respiratory, Inflammation, and Autoimmune Diseases, AstraZeneca, Mölndal, Sweden.
Chest. 2014 May;145(5):1016-1024. doi: 10.1378/chest.13-1398.
The Short Physical Performance Battery (SPPB) is commonly used in gerontology, but its determinants have not been previously evaluated in COPD. In particular, it is unknown whether pulmonary aspects of COPD would limit the value of SPPB as an assessment tool of lower limb function.
In 109 patients with COPD, we measured SPPB score, spirometry, 6-min walk distance, quadriceps strength, rectus femoris cross-sectional area, fat-free mass, physical activity, health status, and Medical Research Council dyspnea score. In a subset of 31 patients with COPD, a vastus lateralis biopsy was performed, and the biopsy specimen was examined to evaluate the structural muscle characteristics associated with SPPB score. The phenotypic characteristics of patients stratified according to SPPB were determined.
Quadriceps strength and 6-min walk distance were the only independent predictors of SPPB score in a multivariate regression model. Furthermore, while age, dyspnea, and health status were also univariate predictors of SPPB score, FEV 1 was not. Stratification by reduced SPPB score identified patients with locomotor muscle atrophy and increasing impairment in strength, exercise capacity, and daily physical activity. Patients with mild or major impairment defined as an SPPB score < 10 had a higher proportion of type 2 fibers (71% [14] vs 58% [15], P = .04).
The SPPB is a valid and simple assessment tool that may detect a phenotype with functional impairment, loss of muscle mass, and structural muscle abnormality in stable patients with COPD.
短体力量测试（SPPB）常用于老年医学，但在 COPD 中尚未对其决定因素进行评估。特别是，尚不清楚 COPD 的肺部情况是否会限制 SPPB 作为下肢功能评估工具的价值。
在 109 例 COPD 患者中，我们测量了 SPPB 评分、肺量测定、6 分钟步行距离、股四头肌力量、股直肌横截面积、去脂体重、身体活动、健康状况和医学研究委员会呼吸困难评分。在 31 例 COPD 患者的亚组中，进行了股外侧肌活检，并对活检标本进行了检查，以评估与 SPPB 评分相关的结构性肌肉特征。根据 SPPB 对患者进行分层，确定其表型特征。
在多元回归模型中，股四头肌力量和 6 分钟步行距离是 SPPB 评分的唯一独立预测因子。此外，虽然年龄、呼吸困难和健康状况也是 SPPB 评分的单因素预测因子，但 FEV 1 不是。根据 SPPB 评分降低进行分层，确定了存在运动肌肉萎缩和力量、运动能力和日常体力活动逐渐受损的患者。定义为 SPPB 评分<10 的轻度或重度损伤患者，Ⅱ型纤维比例更高（71%[14]比 58%[15]，P=0.04）。
SPPB 是一种有效且简单的评估工具，可在稳定的 COPD 患者中检测到具有功能障碍、肌肉质量丧失和结构性肌肉异常的表型。
