Ezponda Ana, Casanova Ciro, Cabrera Carlos, Martin-Palmero Ángela, Marin-Oto Marta, Marín Jose M, Pinto-Plata Víctor, Divo Miguel, Celli Bartolome R, Zulueta Javier J, Bastarrika Gorka, de-Torres Juan P
Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain.
Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain.
Arch Bronconeumol (Engl Ed). 2021 Apr 26. doi: 10.1016/j.arbres.2021.04.012.
Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality.
At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality.
PsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p=0.023) were the variables independently associated with all-cause mortality.
In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.
慢性阻塞性肺疾病（COPD）患者的肌肉质量较差与运动不耐受和死亡率相关。可通过计算机断层扫描（CT）评估腰大肌密度（PsD）来估计肌肉质量。我们检验了以下假设：COPD患者的PsD低于对照组，且与全因死亡率相关。
在基线时，使用轴向低剂量胸部CT图像测量了220例COPD患者的PsD，这些患者中80%为男性，年龄为65±8岁，存在轻度至重度气流受限；同时测量了58名年龄、性别、体重指数（BMI）和体表面积（BSA）相匹配的对照组受试者的PsD。对COPD患者进行了76.5（48 - 119）个月的前瞻性随访。记录了人体测量学指标（身高、体重等）、吸烟史、BMI、呼吸困难程度、肺功能、运动能力、BODE指数和急性加重病史。采用Cox比例风险分析确定与长期死亡率更密切相关的因素。
COPD患者的PsD低于对照组（40.5对42.5，p = 0.045）。在随访期间，COPD组有54例（24.5%）死亡。PsD以及年龄、性别、吸烟包年史、第1秒用力呼气容积占预计值百分比（FEV%）、6分钟步行距离（6MWD）、改良英国医学研究委员会呼吸困难量表（mMRC）评分、BODE指数均与死亡率独立相关。多因素分析显示，年龄（风险比[HR] 1.06；95%置信区间[CI] 1.02 - 1.12，p = 0.006）和CT评估的PsD（HR 0.97；95%CI 0.94 - 0.99，p = 0.023）是与全因死亡率独立相关的变量。
在轻度至重度气流受限的COPD患者中，胸部CT评估的腰大肌密度低于匹配的对照组，且与长期死亡率独立相关。利用胸部CT易于评估的腰大肌密度来评估肌肉质量，可能为临床医生提供COPD患者重要的预后信息。
