Song Qing, Zhou Aiyuan, Lin Ling, Li Xueshan, Cheng Wei, Liu Cong, Peng Yating, Zeng Yuqin, Yi Rong, Liu Yi, Li Xin, Chen Yan, Cai Shan, Chen Ping
Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China.
Front Pharmacol. 2023 Jul 13;14:1131614. doi: 10.3389/fphar.2023.1131614. eCollection 2023.
This study aimed to analyze the clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease (COPD) with low body mass index (BMI). In this cross-sectional study, we enrolled patients with stable COPD from the database setup by the Second Xiangya Hospital of Central South University. We classified the patients into three groups based on BMI: low-BMI (<18.5 kg/m), normal-BMI (≥18.5 and <24.0 kg/m), and high-BMI (≥24 kg/m) groups. We defined clinically important deterioration (CID) as a COPD Assessment Test (CAT) score increase of ≥2 and minimum clinically important difference (MCID) as a CAT score decrease of ≥2 during 6 months of follow-up. We recorded the number of exacerbations and mortality during 1 year of follow-up. A total of 910 COPD patients were included with 144 (15.8%) patients in low-BMI, 475 (52.2%) in normal-BMI, and 291 (32.0%) in high-BMI groups. Patients with low BMI had worse pulmonary function, higher symptom scores, and exacerbations in the past year compared with normal- and high-BMI groups ( < 0.05). Logistic regression analysis revealed that age, Global Initiative for Chronic Obstructive Lung Disease grades 3 and 4, and hospitalizations in the past year were independent risk factors for patients with low BMI ( < 0.05). After 1 year of follow-up, patients with low BMI had higher mortality and number of hospitalizations. Patients with low BMI were more likely to attain CID and less likely to attain MCID compared with patients with high BMI ( < 0.05). In addition, patients with low BMI treated with long-acting β2-agonist (LABA)+long-acting muscarinic antagonist (LAMA) and LABA+LAMA+inhaled corticosteroid (ICS) were more likely to attain MCID than those treated with LABA+ICS and LAMA ( < 0.05). COPD patients with low BMI had worse pulmonary function, higher symptom scores, and higher risk of future hospitalizations and mortality and were less likely to attain MCID and more likely to attain CID. It is worth noting that patients with low BMI treated with LABA+LAMA and LABA+LAMA+ICS were more likely to attain MCID than those treated with LABA+ICS and LAMA.
本研究旨在分析低体重指数（BMI）的慢性阻塞性肺疾病（COPD）患者的临床特征及治疗反应。在这项横断面研究中，我们从中南大学湘雅二医院建立的数据库中纳入了稳定期COPD患者。我们根据BMI将患者分为三组：低BMI组（<18.5 kg/m²）、正常BMI组（≥18.5且<24.0 kg/m²）和高BMI组（≥24 kg/m²）。我们将临床重要恶化（CID）定义为慢性阻塞性肺疾病评估测试（CAT）评分增加≥2分，将最小临床重要差异（MCID）定义为随访6个月期间CAT评分降低≥2分。我们记录了随访1年期间的急性加重次数和死亡率。共纳入910例COPD患者，其中低BMI组144例（15.8%），正常BMI组475例（52.2%），高BMI组291例（32.0%）。与正常BMI组和高BMI组相比，低BMI患者的肺功能更差、症状评分更高且过去一年急性加重次数更多（P<0.05）。逻辑回归分析显示，年龄、慢性阻塞性肺疾病全球倡议组织3级和4级以及过去一年的住院次数是低BMI患者的独立危险因素（P<0.05）。随访1年后，低BMI患者的死亡率和住院次数更高。与高BMI患者相比，低BMI患者更易出现CID且更不易达到MCID（P<0.05）。此外，与接受长效β2受体激动剂（LABA）+长效毒蕈碱拮抗剂（LAMA）和LABA+LAMA+吸入性糖皮质激素（ICS）治疗的患者相比，接受LABA+ICS和LAMA治疗的低BMI患者更不易达到MCID（P<0.05）。低BMI的COPD患者肺功能更差、症状评分更高，未来住院和死亡风险更高，且更不易达到MCID而更易出现CID。值得注意的是，与接受LABA+ICS和LAMA治疗的患者相比接受LABA+LAMA和LABA+LAMA+ICS治疗的低BMI患者更易达到MCID。
