Division of Pulmonary, Critical Care and Sleep Medicine Department of Medicine, University of Florida, 1600 SW Archer Road, M415, PO BOX 100225, Gainesville, FL, 32610, USA.
Division of Pulmonary, Critical Care and Sleep Medicine Department of Medicine, University at Buffalo State University of New York, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
Lung. 2017 Dec;195(6):729-738. doi: 10.1007/s00408-017-0053-y. Epub 2017 Oct 9.
Alterations in body composition are commonly present in chronic obstructive pulmonary disease (COPD). The hypothesis of this study is that COPD patients would achieve clinical benefits after pulmonary rehabilitation (PR) independent of muscle mass depletion or body weight.
We conducted a retrospective cohort study using single-frequency bioelectrical impedance analysis (BIA) for assessment of fat-free mass (FFM) depletion (muscle depletion). Patients were stratified into three categories based on (1) obesity BMI ≥ 30 kg/m, (2) non-obesity BMI < 30 kg/m, and (3) combined cachexia (BMI < 21 kg/m and FFM index < 16 kg/m) and muscle atrophy (BMI ≥ 21 kg/m and FFMI < 16 kg/m). PR outcomes were defined as the improvement in exercise capacity (maximal exercise capacity, 6-min walk, constant workload cycle exercise duration) and quality of life determined by Chronic Respiratory Questionnaire after PR.
We studied 72 patients with available FFM measured by BIA. Patients were predominantly elderly man (N = 71; 98%), with a mean age of 72 years with COPD GOLD stage I-IV. The groups were balanced in terms of age, comorbidities, baseline FEV1, exercise capacity, and quality of life. The absolute changes in patients with muscle depletion or obesity compared to those without muscle depletion or obesity were not statistically different as was the percentage of patients reaching the minimal clinically important difference (MCID) after PR.
A comprehensive PR program in COPD patients improved exercise tolerance and quality of life independent of muscle mass depletion or obesity. Similarly, muscle depletion or obesity had no effect on the percentage of patients achieving the MCID for measures of quality of life and exercise tolerance after PR.
在慢性阻塞性肺疾病（COPD）中，身体成分的改变是常见的。本研究的假设是，COPD 患者在接受肺康复（PR）后，无论肌肉质量减少还是体重减轻，都会获得临床益处。
我们进行了一项回顾性队列研究，使用单频生物电阻抗分析（BIA）评估去脂体重（FFM）的消耗（肌肉消耗）。患者根据以下三种情况进行分层：（1）肥胖 BMI≥30kg/m，（2）非肥胖 BMI<30kg/m，（3）合并恶病质（BMI<21kg/m 和 FFM 指数<16kg/m）和肌肉萎缩（BMI≥21kg/m 和 FFMI<16kg/m）。PR 后的运动能力（最大运动能力、6 分钟步行、恒负荷循环运动持续时间）和生活质量（由慢性呼吸系统问卷确定）的改善定义为 PR 结果。
我们研究了 72 例可通过 BIA 测量 FFM 的患者。患者主要为老年男性（N=71；98%），平均年龄为 72 岁，COPD GOLD 分级 I-IV 期。在年龄、合并症、基线 FEV1、运动能力和生活质量方面，各组之间平衡。与无肌肉消耗或肥胖的患者相比，有肌肉消耗或肥胖的患者的绝对变化在统计学上没有差异，PR 后达到最小临床重要差异（MCID）的患者比例也没有差异。
全面的 COPD 患者 PR 方案可改善运动耐量和生活质量，与肌肉质量消耗或肥胖无关。同样，肌肉消耗或肥胖对 PR 后生活质量和运动耐量测量达到 MCID 的患者比例没有影响。
