Samaras Nikolaos, Samaras Dimitrios, Chambellan Arnaud, Pichard Claude, Thibault Ronan
Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Nutrition Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Biomed Res Int. 2014;2014:248420. doi: 10.1155/2014/248420. Epub 2014 Feb 19.
Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to increase in future decades. Androgenopenia is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies have shown that androgen substitution could improve muscle mass in COPD patients, but alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation which is the reference therapy of COPD-associated undernutrition.
慢性阻塞性肺疾病（COPD）兼具慢性缺氧、慢性炎症、胰岛素抵抗、能量消耗增加、肌肉萎缩和运动能力下降等有害影响。与其他慢性疾病一样，去脂体重的减少会降低生存率。通过保护线粒体氧化代谢来维持肌肉质量和功能，是COPD患者管理中的一项重要挑战。随着该疾病患病率的上升以及医学进步使COPD患者寿命延长，预计在未来几十年中，COPD相关营养障碍的患病率将会增加。40%的COPD患者存在雄激素缺乏。由于雄激素对肌肉合成代谢有刺激作用，雄激素缺乏会促使肌肉质量流失。研究表明，雄激素替代疗法可改善COPD患者的肌肉质量，但单独使用不足以改善肺功能。两项多中心随机临床试验表明，雄激素治疗与体育锻炼以及含有ω-3多不饱和脂肪酸的口服营养补充剂联合使用，至少持续三个月，与改善临床结局和生存率相关。这些方法在肺康复领域得到了优化，肺康复是COPD相关营养不良的参考治疗方法。
