Hwang Ji An, Kim Young Sam, Leem Ah Young, Park Moo Suk, Kim Se Kyu, Chang Joon, Jung Ji Ye
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Chest. 2017 May;151(5):1018-1027. doi: 10.1016/j.chest.2016.12.006. Epub 2016 Dec 21.
Sarcopenia and osteoporosis are systemic features of COPD. The present study investigated the association between sarcopenia and osteopenia/osteoporosis and the factors associated with low bone mineral density (BMD) in men with COPD.
Data from 777 men with COPD who underwent both pulmonary function test and dual-energy x-ray absorptiometry were extracted from the Korean National Health and Nutritional Examination Survey database between 2008 and 2011. Sarcopenia was assessed with the appendicular skeletal mass index (ASMI) and osteopenia/osteoporosis with the T-score.
As the severity of airflow limitation increased, the prevalence of sarcopenia increased (P < .001). Additionally, as the degree of sarcopenia became severe, the prevalence of osteopenia/osteoporosis increased (P < .001), and a significant positive correlation was noted between appendicular skeletal muscle mass and BMD (ASMI/T-score: r = 0.408; P < .001). Sarcopenia was independently associated with an increased risk of low BMD in men with COPD (OR, 2.31; 95% CI, 1.53-3.46; P < .001). Old age and low fat mass were significantly associated with low BMD in both sarcopenic and non-sarcopenic participants. High serum hemoglobin and insulin levels were associated with a reduced risk of low BMD only in the sarcopenic participants, whereas exercise and dietary intake were associated with a reduced risk only in the non-sarcopenic participants.
Sarcopenia is closely correlated with osteopenia/osteoporosis in men with COPD. Moreover, different factors are associated with low BMD according to the presence/absence of sarcopenia in that population.
肌肉减少症和骨质疏松症是慢性阻塞性肺疾病（COPD）的全身性特征。本研究调查了COPD男性患者中肌肉减少症与骨质减少/骨质疏松症之间的关联以及与低骨密度（BMD）相关的因素。
从2008年至2011年的韩国国家健康与营养检查调查数据库中提取了777例接受肺功能测试和双能X线吸收测定法的COPD男性患者的数据。采用四肢骨骼肌质量指数（ASMI）评估肌肉减少症，采用T值评估骨质减少/骨质疏松症。
随着气流受限严重程度的增加，肌肉减少症的患病率增加（P <.001）。此外，随着肌肉减少症程度加重，骨质减少/骨质疏松症的患病率增加（P <.001），并且四肢骨骼肌质量与BMD之间存在显著正相关（ASMI/T值：r = 0.408；P <.001）。肌肉减少症与COPD男性患者低BMD风险增加独立相关（OR，2.3；95%CI，1.53 - 3.46；P <.001）。在有肌肉减少症和无肌肉减少症的参与者中，老年和低脂肪量均与低BMD显著相关。高血清血红蛋白和胰岛素水平仅在有肌肉减少症的参与者中与低BMD风险降低相关，而运动和饮食摄入仅在无肌肉减少症的参与者中与低BMD风险降低相关。
COPD男性患者中肌肉减少症与骨质减少/骨质疏松症密切相关。此外，根据该人群中是否存在肌肉减少症，不同因素与低BMD相关。
