Li Lun, Liu Yi, Li Jia, Gao Jin Ming
Department of Respiratory Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Department of Respiratory Medicine,Civil Aviation General Hospital,Beijing 100123,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020 Feb 28;42(1):55-61. doi: 10.3881/j.issn.1000-503X.11206.
To investigate the clinical values of nutritional status and chest CT phenotypes in the assessment of chronic obstructive pulmonary disease(COPD). A total of 256 patients with stable COPD were enrolled from Peking Union Medical College Hospital and Civil Aviation General Hospital from June 2017 to June 2018.Demographic data,height,weight,smoking history,and number of exacerbations were collected.Pulmonary function tests and COPD assessment test(CAT)questionnaire-based survey were performed.The correlations of Goddard score with pulmonary function,CAT score,and number of exacerbations were analyzed.The clinical features of COPD patients with different body mass index(BMI)grades and CT phenotype were analyzed. The forced expiratory volume in one second as percentage of predicted value(FEV%pred)was significantly higher in normal body mass group(=-2.701,=0.0080),overweight group(=-3.506,=0.001),and obese group(=-4.323,=0.000)than in low body mass group and was significantly higher in obese group than in normal body mass group(=-3.096,=0.002).The forced vital capacity as percentage of predicted value(FVC%pred)of normal body mass group(=-3.081,=0.002)and overweight group(=-2.766,=0.006)were significantly higher than that of low body mass group.The forced expiratory volume in one second(FEV)/forced vital capacity(FVC)was significantly higher in overweight group than in normal body mass group(=-3.702,=0.001)and significantly higher in obese group than in low body mass group(=-4.742,=0.000),normal body mass group(=-5.785,=0.000),and overweight group(=-2.984,=0.003).In addition,the carbon monoxide diffusing capacity as percentage of predicted value(DLco%pred)was significantly higher in overweight group than in underweight(=-3.042,=0.003)and normal body mass groups(=-3.128,=0.002)and significantly higher in obese group than in underweight group(=-4.742,=0.000)and normal body mass group(=-5.785,=0.000).The Goddard scores of overweight(=4.535,=0.000)and obese groups(=5.422,=0.000)were significantly lower than that of normal body mass group.Partial correlation analysis showed that Goddard score was negatively correlated with FEV/FVC( =-0.230, = 0.022)and DLco%pred( =-0.531, = 0.000)and positively correlated with CAT score( = 0.244, = 0.021).BMI of phenotype E(=3.467,=0.001)and M(=3.031,=0.003),FEV/FVC of phenotype E(=2.484,=0.015)and M(=2.969,=0.004)as well as DLco%pred of phenotype E(=4.928,=0.000)and M(=2.489,=0.0163)were significantly lower than those of phenotype A.Patients with phenotype M had worse FEV%pred,FVC%pred,residual volume/total lung capacity and number of acute exacerbations than patients with phenotypes A and E,but the differences were not statistically significant(all >0.05). The nutritional status is closely related to lung function,severity of emphysema,and number of exacerbations in COPD patients.Chest CT phenotype is clinically valuable in the assessment of COPD.
探讨营养状况和胸部CT表型在慢性阻塞性肺疾病（COPD）评估中的临床价值。2017年6月至2018年6月，从北京协和医院和民航总医院招募了256例稳定期COPD患者。收集人口统计学数据、身高、体重、吸烟史和急性加重次数。进行肺功能测试和基于COPD评估测试（CAT）问卷的调查。分析戈达德评分与肺功能、CAT评分和急性加重次数的相关性。分析不同体重指数（BMI）等级和CT表型的COPD患者的临床特征。正常体重组（=-2.701，=0.0080）、超重组（=-3.506，=0.001）和肥胖组（=-4.323，=0.000）的一秒用力呼气容积占预计值百分比（FEV%pred）显著高于低体重组，且肥胖组显著高于正常体重组（=-3.096，=0.002）。正常体重组（=-3.081，=0.002）和超重组（=-2.766，=0.006）的用力肺活量占预计值百分比（FVC%pred）显著高于低体重组。超重组的一秒用力呼气容积（FEV）/用力肺活量（FVC）显著高于正常体重组（=-3.702，=0.001），肥胖组显著高于低体重组（=-4.742，=0.000）、正常体重组（=-5.785，=0.000）和超重组（=-2.984，=0.003）。此外，超重组的一氧化碳弥散量占预计值百分比（DLco%pred）显著高于体重过低组（=-3.042，=0.003）和正常体重组（=-3.128，=0.002），肥胖组显著高于体重过低组（=-4.742，=0.000）和正常体重组（=-5.785，=0.000）。超重组（=4.535，=0.000）和肥胖组（=5.422，=0.000）的戈达德评分显著低于正常体重组。偏相关分析显示，戈达德评分与FEV/FVC（=-0.230，=0.022）和DLco%pred（=-0.531，=0.000）呈负相关，与CAT评分呈正相关（=0.244，=0.021）。表型E（=3.467，=0.001）和M（=3.031，=0.003）的BMI以及表型E（=2.484，=0.015）和M（=2.969，=0.004）的FEV/FVC以及表型E（=4.928，=0.000）和M（=2.489，=0.0163）的DLco%pred均显著低于表型A。表型M的患者在FEV%pred、FVC%pred、残气量/肺总量和急性加重次数方面比表型A和E的患者更差，但差异无统计学意义（均>0.05）。营养状况与COPD患者的肺功能、肺气肿严重程度和急性加重次数密切相关。胸部CT表型在COPD评估中具有临床价值。
