Holmes Sarah J, Allen Stephen C, Roberts Helen C
Medicine and Elderly Care, Hampshire Hospitals NHS Foundation Trust, Winchester.
Medicine and Geriatrics, The Royal Bournemouth Hospital and Christchurch Hospitals NHS Foundation Trust, Bournemouth.
Int J Chron Obstruct Pulmon Dis. 2017 Apr 19;12:1207-1212. doi: 10.2147/COPD.S120721. eCollection 2017.
Older people with reduced respiratory muscle strength may be misclassified as having COPD on the basis of spirometric results. We aimed to evaluate the relationship between lung function and grip strength in older hospitalized patients without known airways disease.
Patients in acute medical wards were recruited who were aged ≥70 years; no history, symptoms, or signs of respiratory disease; Mini Mental State Examination ≥24; willing and able to consent to participate; and able to perform hand grip and forced spirometry. Data including lung function (forced expiratory volume in 1 second [FEV], forced vital capacity [FVC], FEV/FVC, peak expiratory flow rate [PEFR], and slow vital capacity [SVC]), grip strength, age, weight, and height were recorded. Data were analyzed using descriptive statistics and linear regression unadjusted and adjusted (for age, height, and weight).
A total of 50 patients (20 men) were recruited. Stronger grip strength in men was significantly associated with greater FEV, but this was attenuated by adjustment for age, height, and weight. Significant positive associations were found in women between grip strength and both PEFR and SVC, both of which remained robust to adjustment.
The association between grip strength and PEFR and SVC may reflect stronger patients generating higher intrathoracic pressure at the start of spirometry and pushing harder against thoracic cage recoil at end-expiration. Conversely, patients with weaker grip strength had lower PEFR and SVC. These patients may be misclassified as having COPD on the basis of spirometric results.
呼吸肌力量减弱的老年人可能会根据肺功能测定结果被误诊为慢性阻塞性肺疾病（COPD）。我们旨在评估无已知气道疾病的老年住院患者肺功能与握力之间的关系。
招募年龄≥70岁、无呼吸系统疾病病史、症状或体征、简易精神状态检查表得分≥24、愿意且能够同意参与、能够进行握力测试和用力肺活量测定的急性内科病房患者。记录包括肺功能（一秒用力呼气容积[FEV]、用力肺活量[FVC]、FEV/FVC、呼气峰值流速[PEFR]和慢肺活量[SVC]）、握力、年龄、体重和身高的数据。使用描述性统计以及未调整和调整（针对年龄、身高和体重）的线性回归分析数据。
共招募了50名患者（20名男性）。男性较强的握力与更大的FEV显著相关，但在对年龄、身高和体重进行调整后这种相关性减弱。在女性中发现握力与PEFR和SVC均存在显著正相关，且在调整后两者均保持显著。
握力与PEFR和SVC之间的关联可能反映出较强壮的患者在肺活量测定开始时产生更高的胸内压，并在呼气末更用力地对抗胸廓回弹。相反，握力较弱的患者PEFR和SVC较低。这些患者可能会根据肺功能测定结果被误诊为患有COPD。
