COPD 中的肌肉减少症表型与英国生物库中的不良结局相关。
Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank.
机构信息
Departments of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA.
Center for Populations Health Research, Cleveland Clinic, Cleveland, OH, USA.
出版信息
BMC Pulm Med. 2024 Apr 17;24(1):186. doi: 10.1186/s12890-024-02999-7.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality.
METHODS
A retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio.
RESULTS
There were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death.
CONCLUSIONS
Evidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.
背景
慢性阻塞性肺疾病（COPD）是一种慢性炎症性疾病，具有全身性后果，可导致肌肉减少表型（MLP），其特征是肌肉质量、肌肉力量或肌肉和脂肪质量的损失。在 COPD 患者的大型无偏倚队列中，比较 MLP 的个体特征与临床结局的相关数据有限。我们的目的是确定在人群水平上，在 COPD 患者的无偏倚样本中，符合 MLP 标准的患者比例。我们还确定了特定的 MLP 特征是否与全因和 COPD 相关死亡率相关。
方法
对英国生物库进行了回顾性人群队列分析。COPD 通过以下一种或多种方式定义：1）生物电阻抗分析（BIA）的低去脂体重指数（FFMI）或 2）BIA 的四肢骨骼肌指数（ASMI），3）低握力定义的肌肉力量，或 4）基于体重指数（BMI）的低肌肉和脂肪量。使用 Cox 回归来确定 MLP 与全因或 COPD 相关死亡率之间的关联。所有模型均调整了性别、评估时的年龄、种族、BMI、饮酒、吸烟状况、既往癌症诊断和 FEV1/FVC 比值。
结果
共有 55782 名（56%为男性）COPD 患者，中位随访时间为 70.1 个月，平均（±SD）评估时年龄为 59±7.5 岁，FEV1%为 79.2±18.5。大多数患者患有轻度（50.4%）或中度（42.8%）COPD。许多患者存在 MLP 的证据，COPD 患者中有 53.4%存在 MLP（34%通过 ASMI，26%通过 HGS）。在诊断为 COPD 的患者中，有 5608 例死亡，其中 907 例与 COPD 相关。经过多变量调整后，有 MLP 的 COPD 患者全因死亡的危险比增加 30%，与 COPD 相关的死亡的危险比增加 70%。
结论
在 COPD 的大型基于人群的队列中，MLP 的证据很常见，并且与全因和 COPD 相关死亡率的风险增加相关。
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