无症状肥胖受试者的肺功能和心脏功能以及结构化减肥计划后的变化：一项前瞻性观察研究。

Pulmonary and cardiac function in asymptomatic obese subjects and changes following a structured weight reduction program: a prospective observational study.

作者信息

Held Matthias, Mittnacht Maria, Kolb Martin, Karl Sabine, Jany Berthold

机构信息

Medical Mission Hospital, Academic Teaching Hospital, Julius Maximilian University of Würzburg, Department of Internal Medicine, Würzburg, Germany.

Firestone Institute for Respiratory Health, Department of Medicine, Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada.

出版信息

PLoS One. 2014 Sep 18;9(9):e107480. doi: 10.1371/journal.pone.0107480. eCollection 2014.

DOI:10.1371/journal.pone.0107480

PMID:25233078

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4169401/

Abstract

BACKGROUND

The prevalence of obesity is rising. Obesity can lead to cardiovascular and ventilatory complications through multiple mechanisms. Cardiac and pulmonary function in asymptomatic subjects and the effect of structured dietary programs on cardiac and pulmonary function is unclear.

OBJECTIVE

To determine lung and cardiac function in asymptomatic obese adults and to evaluate whether weight loss positively affects functional parameters.

METHODS

We prospectively evaluated bodyplethysmographic and echocardiographic data in asymptomatic subjects undergoing a structured one-year weight reduction program.

RESULTS

74 subjects (32 male, 42 female; mean age 42±12 years) with an average BMI 42.5±7.9, body weight 123.7±24.9 kg were enrolled. Body weight correlated negatively with vital capacity (R = -0.42, p<0.001), FEV1 (R = -0.497, p<0.001) and positively with P 0.1 (R = 0.32, p = 0.02) and myocardial mass (R = 0.419, p = 0.002). After 4 months the study subjects had significantly reduced their body weight (-26.0±11.8 kg) and BMI (-8.9±3.8) associated with a significant improvement of lung function (absolute changes: vital capacity +5.5±7.5% pred., p<0.001; FEV1+9.8±8.3% pred., p<0.001, ITGV+16.4±16.0% pred., p<0.001, SR tot -17.4±41.5% pred., p<0.01). Moreover, P0.1/Pimax decreased to 47.7% (p<0.01) indicating a decreased respiratory load. The change of FEV1 correlated significantly with the change of body weight (R = -0.31, p = 0.03). Echocardiography demonstrated reduced myocardial wall thickness (-0.08±0.2 cm, p = 0.02) and improved left ventricular myocardial performance index (-0.16±0.35, p = 0.02). Mitral annular plane systolic excursion (+0.14, p = 0.03) and pulmonary outflow acceleration time (AT +26.65±41.3 ms, p = 0.001) increased.

CONCLUSION

Even in asymptomatic individuals obesity is associated with abnormalities in pulmonary and cardiac function and increased myocardial mass. All the abnormalities can be reversed by a weight reduction program.

摘要

背景

肥胖的患病率正在上升。肥胖可通过多种机制导致心血管和通气并发症。无症状受试者的心脏和肺功能以及结构化饮食计划对心脏和肺功能的影响尚不清楚。

目的

确定无症状肥胖成年人的肺和心脏功能，并评估体重减轻是否对功能参数有积极影响。

方法

我们前瞻性地评估了接受为期一年结构化减重计划的无症状受试者的体容积描记和超声心动图数据。

结果

纳入了74名受试者（32名男性，42名女性；平均年龄42±12岁），平均BMI为42.5±7.9，体重为123.7±24.9kg。体重与肺活量（R = -0.42，p<0.001）、第一秒用力呼气容积（FEV1，R = -0.497，p<0.001）呈负相关，与口腔阻断压（P0.1，R = 0.32，p = 0.02）和心肌质量（R = 0.419，p = 0.002）呈正相关。4个月后，研究对象的体重（-26.0±11.8kg）和BMI（-8.9±3.8）显著降低，同时肺功能得到显著改善（绝对变化：肺活量增加5.5±7.5%预计值，p<0.001；FEV1增加9.8±8.3%预计值，p<0.001，胸腔内气体容积增加16.4±16.0%预计值，p<0.001，总呼吸阻力降低17.4±41.5%预计值，p<0.01）。此外，P0.1/最大吸气压降至47.7%（p<0.01），表明呼吸负荷降低。FEV1的变化与体重变化显著相关（R = -0.31，p = 0.03）。超声心动图显示心肌壁厚度降低（-0.08±0.2cm，p = 0.02），左心室心肌性能指数改善（-0.16±0.35，p = 0.02）。二尖瓣环平面收缩期位移增加（+0.14，p = 0.03），肺动脉流出加速时间增加（AT +26.65±41.3ms，p = 0.001）。