Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, Oxford University Churchill Campus, and Oxford University Hospitals NHS Trust , Oxford , UK.
Lane Fox Clinical Respiratory Physiology Centre, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust , London , UK.
BMJ Open Respir Res. 2016 Feb 18;3(1):e000110. doi: 10.1136/bmjresp-2015-000110. eCollection 2016.
Only a third of obese patients develop chronic ventilatory failure. This cross-sectional study assessed multiple factors potentially associated with chronic ventilatory failure.
MATERIALS/PATIENTS AND METHODS: Participants had a body mass index (BMI) >30 kg/m(2), with or without chronic ventilatory failure (awake arterial partial pressure of carbon dioxide >6 kPa or base excess (BE) ≥2 mmols/L). Factors investigated were grouped into domains: (1) obesity measures, (2) pulmonary function, (3) respiratory and non-respiratory muscle strength, (4) sleep study derivatives, (5) hypoxic and hypercapnic responses, and (6) some hormonal, nutritional and inflammatory measures.
71 obese participants (52% male) were studied over 27 months, 52 (SD 9) years and BMI 47 (range 32-74) kg/m(2). The best univariate correlates of BE from each domain were: (1) dual-energy X-ray absorptiometry measurement of visceral fat (r=+0.50, p=0.001); (2) supine forced expiratory volume in 1 s (r=-0.40, p=0.001); (3) sniff maximum pressure (r=-0.28, p=0.02); (4) mean overnight arterial oxygen saturation (r=-0.50, p<0.001); (5) ventilatory response to 15% O2 breathing (r=-0.28, p=0.02); and (6) vitamin D (r=-0.30, p=0.01). In multivariate analysis, only visceral fat and ventilatory response to hypoxia remained significant.
We have confirmed that in the obese, BMI is a poor correlate of chronic ventilatory failure, and the best independent correlates are visceral fat and hypoxic ventilatory response.
NCT01380418.
仅有三分之一的肥胖患者会发展为慢性通气衰竭。本横断面研究评估了多种可能与慢性通气衰竭相关的因素。
材料/患者和方法：参与者的体重指数（BMI）>30kg/m²，伴有或不伴有慢性通气衰竭（清醒动脉二氧化碳分压>6kPa 或基础碱剩余（BE）≥2mmol/L）。研究的因素分为以下几类：（1）肥胖指标；（2）肺功能；（3）呼吸和非呼吸肌力量；（4）睡眠研究衍生指标；（5）低氧和高碳酸血症反应；（6）一些激素、营养和炎症指标。
71 名肥胖参与者（52%为男性）在 27 个月内接受了研究，年龄（52±9）岁，BMI 为 47（范围 32-74）kg/m²。每个领域与 BE 相关性最好的单变量指标分别为：（1）双能 X 射线吸收法测量内脏脂肪（r=+0.50，p=0.001）；（2）仰卧位用力呼气 1 秒量（r=-0.40，p=0.001）；（3）最大口腔吸气压力（r=-0.28，p=0.02）；（4）夜间平均动脉血氧饱和度（r=-0.50，p<0.001）；（5）15%O2 呼吸时的通气反应（r=-0.28，p=0.02）；和（6）维生素 D（r=-0.30，p=0.01）。多变量分析中，只有内脏脂肪和低氧通气反应仍有显著意义。
我们证实，在肥胖人群中，BMI 与慢性通气衰竭相关性较差，最佳的独立相关指标是内脏脂肪和低氧通气反应。
NCT01380418。
