Department of Respiratory Medicine, Research School NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Research and Education, CIRO+, centre of expertise for chronic organ failure, Horn, The Netherlands.
Eur Respir J. 2015 Aug;46(2):336-45. doi: 10.1183/09031936.00197314. Epub 2015 Apr 16.
Decreased physical performance due to loss of muscle mass (i.e. sarcopenia) is prevalent in ageing and appears more pronounced in chronic disease. A comprehensive profile of the sarcopenic phenotype in chronic obstructive pulmonary disease (COPD) is not yet available. The aim of the present study was to characterise prevalence, functional implications and predictive value of sarcopenia with or without abdominal obesity in Dutch COPD patients eligible for pulmonary rehabilitation.505 COPD patients (aged 37-87 years; 57% male) underwent assessment of lung function, body composition and physical functioning, before entering pulmonary rehabilitation. Sarcopenia was assessed by appendicular skeletal muscle index (ASMI) and abdominal obesity by android/gynoid percentage fat mass (A/G%FM) using dual energy X-ray absorptiometry.86.5% of patients were sarcopenic and showed lower physical functioning, while coexistent abdominal obesity (78.0%) resulted in higher physical functioning. Implications on endurance were less pronounced in women. The predictive value for physical functioning was higher for the "three-compartment" model (ASMI, bone mineral content and A/G%FM) than the "two-compartment" model (fat-free mass index and fat mass index) or "one-compartment" model (body mass index).In patients eligible for pulmonary rehabilitation, sarcopenia is highly prevalent in all body mass index categories and associated with impaired strength, and in men also with decreased endurance. Abdominal obesity seems to have protective effects on physical functioning. ASMI is a better predictor for physical functioning than fat-free mass index.
由于肌肉质量减少（即肌肉减少症）导致的身体机能下降在衰老中很常见，在慢性病中更为明显。慢性阻塞性肺疾病（COPD）患者的肌肉减少症表型的综合特征尚不清楚。本研究的目的是描述荷兰 COPD 患者在接受肺康复治疗前的肌肉减少症的流行情况、功能意义和预测价值，以及是否存在腹型肥胖。505 名 COPD 患者（年龄 37-87 岁；57%为男性）接受了肺功能、身体成分和身体功能评估，然后进入肺康复治疗。通过四肢骨骼肌指数（ASMI）和双能 X 射线吸收法测量的腹型肥胖用安卓/女性型体脂肪百分比（A/G%FM）来评估肌肉减少症。86.5%的患者患有肌肉减少症，表现出较低的身体功能，而同时存在的腹型肥胖（78.0%）导致了更高的身体功能。女性耐力方面的影响则不那么明显。对于身体功能，“三分区”模型（ASMI、骨矿物质含量和 A/G%FM）的预测价值高于“两分区”模型（去脂体重指数和脂肪量指数）或“一分区”模型（体重指数）。在有资格接受肺康复治疗的患者中，所有 BMI 类别中都存在很高的肌肉减少症患病率，与肌肉力量下降有关，在男性中还与耐力下降有关。腹型肥胖似乎对身体功能有保护作用。ASMI 是身体功能的更好预测指标，优于去脂体重指数。
