Choi Yong Jun, Park Hye Jung, Cho Jae Hwa, Byun Min Kwang
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Tuberc Respir Dis (Seoul). 2023 Oct;86(4):272-283. doi: 10.4046/trd.2023.0008. Epub 2023 Aug 11.
In patients with chronic obstructive pulmonary disease (COPD), decreased muscle mass is a frequently encountered comorbidity in clinical practice. However, the evaluation of muscle mass in patients with COPD in real-world practice is rare.
We retrospectively reviewed the electronic medical records of all patients with COPD who underwent bioelectrical impedance analysis at least once between January 2011 and December 2021 in three hospitals. Then, we analyzed the performance rate of muscle mass measurement in the patients and the correlation between muscle mass, clinical parameters, and COPD prognosis.
Among the 24,502 patients with COPD, only 270 (1.1%) underwent muscle mass measurements. The total skeletal muscle mass index was significantly correlated with albumin, alanine transaminase, and creatinine to cystatin C ratio in patients with COPD (r=0.1614, p=0.011; r=0.2112, p=0.001; and r=0.3671, p=0.001, respectively). Acute exacerbation of COPD (AE COPD) was significantly correlated with muscle mass, especially the truncal skeletal muscle mass index (TSMI) in males (r=-0.196, p=0.007). In the multivariate analysis, TSMI and cystatin C were significant risk factors for AE COPD (hazard ratio, 0.200 [95% confidence interval, CI, 0.048 to 0.838] and 4.990 [95% CI, 1.070 to 23.278], respectively).
Low muscle mass negatively affects the clinical outcomes in patients with COPD. Despite its clinical significance, muscle mass measurement is performed in a small proportion of patients with COPD. Therefore, protocols and guidelines for the screening of sarcopenia in patients with COPD should be established.
在慢性阻塞性肺疾病（COPD）患者中，肌肉量减少是临床实践中常见的合并症。然而，在实际临床中对COPD患者肌肉量的评估却很少见。
我们回顾性分析了2011年1月至2021年12月期间在三家医院至少接受过一次生物电阻抗分析的所有COPD患者的电子病历。然后，我们分析了患者肌肉量测量的执行率以及肌肉量、临床参数与COPD预后之间的相关性。
在24502例COPD患者中，仅有270例（1.1%）进行了肌肉量测量。COPD患者的总骨骼肌质量指数与白蛋白、丙氨酸转氨酶以及肌酐与胱抑素C的比值显著相关（r分别为0.1614，p = 0.011；r = 0.2112，p = 0.001；r = 0.3671，p = 0.001）。COPD急性加重（AE COPD）与肌肉量显著相关，尤其是男性的躯干骨骼肌质量指数（TSMI）（r = -0.196，p = 0.007）。在多变量分析中，TSMI和胱抑素C是AE COPD的显著危险因素（风险比分别为0.200 [95%置信区间，CI，0.048至0.838]和4.990 [95% CI，1.070至23.278]）。
低肌肉量对COPD患者的临床结局有负面影响。尽管其具有临床意义，但在一小部分COPD患者中进行了肌肉量测量。因此，应制定COPD患者肌肉减少症筛查的方案和指南。
