探讨严重稳定期慢性阻塞性肺疾病患者营养水平与 n-6 和 n-3 多不饱和脂肪酸代谢物的关系。
Exploration of n-6 and n-3 Polyunsaturated Fatty Acids Metabolites Associated with Nutritional Levels in Patients with Severe Stable Chronic Obstructive Pulmonary Disease.
机构信息
Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
Department of Laboratory Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2020 Jul 10;15:1633-1642. doi: 10.2147/COPD.S245617. eCollection 2020.
BACKGROUND AND OBJECTIVE
Severe chronic obstructive pulmonary disease (COPD) is the terminal stage of the disease characterized by declined lung function, malnutrition, and poor prognosis. Such patients cannot tolerate long-time sports rehabilitation owing to dyspnea and fail to achieve the desired therapeutic effect; therefore, increasing nutritional support will be an important strategy for them. The present study applied metabolomics technology to evaluate the correlation between serum concentrations of polyunsaturated fatty acid (PUFA) metabolites, nutritional status, and lung function in patients with COPD to provide a theoretical basis for accurate nutritional support.
MATERIALS AND METHODS
We enrolled 82 patients with stable severe COPD in our hospital. The general characteristics including height, weight, and lung function were recorded. Metabolomics was used to detect the concentrations of serum metabolites of n-3 and n-6 at baseline and at 24 and 52 weeks after enrollment. The correlations between nutrition level and pulmonary function and clinical indicators were evaluated.
RESULTS
The concentrations of n-3 and n-6 increased over time along with the progression of COPD. Body mass index (BMI) and percent of ideal body weight (IBW%) decreased with disease development, and BMI was found to be significantly correlated with FEV1% predicted and FEV1/FVC. Serum levels of n-6 metabolites such as linoleic acid (LA), γ-linoleic acid (GLA), and arachidonic acid (ARA) (all < 0.01) and the n-3 metabolites such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (all < 0.05) showed significant correlations with BMI and were closely correlated with FEV1% predicted and FEV1/FVC of lung function (all < 0.05).
CONCLUSION
This study demonstrates that malnutrition in patients with severe COPD is progressive and is positively correlated with n-3 and n-6 polyunsaturated fatty acids and lung function.
背景与目的
严重慢性阻塞性肺疾病（COPD）是疾病的终末期，以肺功能下降、营养不良和预后不良为特征。此类患者由于呼吸困难无法耐受长时间的运动康复，且无法达到预期的治疗效果，因此增加营养支持将是他们的重要策略。本研究应用代谢组学技术评估 COPD 患者血清多不饱和脂肪酸（PUFA）代谢物浓度、营养状况与肺功能之间的相关性，为准确的营养支持提供理论依据。
材料与方法
我们纳入我院 82 例稳定期重度 COPD 患者，记录一般特征包括身高、体重和肺功能。采用代谢组学检测基线及入组后 24、52 周时血清 n-3 和 n-6 多不饱和脂肪酸代谢物浓度，评估营养水平与肺功能及临床指标的相关性。
结果
随着 COPD 的进展，n-3 和 n-6 的浓度随时间逐渐增加。体质量指数（BMI）和理想体重百分比（IBW%）随疾病进展而降低，且 BMI 与 FEV1%预计值和 FEV1/FVC 显著相关。血清 n-6 代谢物如亚油酸（LA）、γ-亚麻酸（GLA）和花生四烯酸（ARA）（均<0.01）和 n-3 代谢物如二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）（均<0.05）水平与 BMI 呈显著相关，且与肺功能的 FEV1%预计值和 FEV1/FVC 密切相关（均<0.05）。
结论
本研究表明，重度 COPD 患者的营养不良呈进行性发展，与 n-3 和 n-6 多不饱和脂肪酸以及肺功能呈正相关。
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