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. 2021 Aug;57(8):533-539. doi: 10.1016/j.arbr.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.
COPD 患者的肌肉质量差与运动不耐受和死亡率有关。通过估计腰大肌密度（PsD）可以在计算机断层扫描（CT）上估计肌肉质量。我们检验了这样一个假设，即与对照组相比，COPD 患者的 PsD 较低，并且与全因死亡率相关。
在基线时，通过对 220 名 COPD 患者（80%为男性）和 58 名年龄、性别、体重指数（BMI）和体表面积（BSA）匹配的对照组进行轴向低剂量胸部 CT 图像测量了 PsD，患者年龄为 65±8 岁，有轻至重度气流受限。前瞻性随访 COPD 患者 76.5（48-119）个月。记录了人体测量学、吸烟史、BMI、呼吸困难、肺功能、运动能力、BODE 指数和加重史。Cox 比例风险分析确定了与长期死亡率更密切相关的因素。
与对照组相比，COPD 患者的 PsD 较低（40.5 比 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、吸烟包年数、FEV%、6MWD、mMRC、BODE 指数均与死亡率独立相关。多变量分析显示，年龄（HR 1.06；95%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。
在有轻至重度气流受限的 COPD 患者中，胸部 CT 评估的腰大肌密度低于匹配对照组，并且与长期死亡率独立相关。使用胸部 CT 易于评估的腰大肌密度来评估肌肉质量可能为 COPD 患者提供重要的预后信息。
