Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
Respiration. 2024;103(9):572-582. doi: 10.1159/000539734. Epub 2024 Jun 13.
Patients with chronic obstructive pulmonary disease (COPD) and emphysema experience malnutrition and pulmonary cachexia. Endoscopic lung volume reduction (ELVR) with endobronchial valves has not only improved lung function, exercise capacity, and quality of life but also influenced body weight. Only a few data are available on body composition changes after ELVR.
This single-center prospective study of patients with advanced COPD investigates body composition before and after endoscopic valve treatment using multifrequency bioelectrical impedance analysis (BIA). The following parameters were evaluated in addition to clinical data and routine tests: body weight, body mass index (BMI), basal metabolic rate, total body water, body fat, cell percentage, phase angle, intracellular water (ICW), extracellular water (ECW), extracellular mass (ECM), body cell mass (BCM), lean body mass (ECM + BCM), and fat-free mass index.
A total of 23 patients (mean emphysema index 37.2 ± 7.5%, BMI 23.4 ± 4.3 kg/m2) experienced improvements in lung function and exercise capacity with ELVR. Complete lobar atelectasis was achieved in 39.1% of participants. A non-statistically significant increase in body weight and BMI was observed after ELVR (p = 0.111 and p = 0.102). BIA measurement revealed a worsening of phase angle, cell percentage and ECM/BCM and thus of body composition, but without statistical significance. This is mainly due to a statistically significant increase in ECM, ECW, and ICW (all p < 0.001).
ELVR demonstrated no beneficial changes in body composition, although patients tend to gain weight. A larger cohort is warranted to confirm these findings.
患有慢性阻塞性肺疾病（COPD）和肺气肿的患者会出现营养不良和肺恶病质。支气管镜肺减容术（ELVR）联合支气管内瓣膜不仅改善了肺功能、运动能力和生活质量，还影响了体重。仅有少量数据可用于评估 ELVR 后身体成分的变化。
这项针对晚期 COPD 患者的单中心前瞻性研究，使用多频生物电阻抗分析（BIA）调查了内镜瓣膜治疗前后的身体成分。除了临床数据和常规检查外，还评估了以下参数：体重、体重指数（BMI）、基础代谢率、总体水、体脂肪、细胞百分比、相位角、细胞内液（ICW）、细胞外液（ECW）、细胞外基质（ECM）、身体细胞质量（BCM）、瘦体重（ECM+BCM）和去脂体重指数。
共有 23 名患者（平均肺气肿指数 37.2 ± 7.5%，BMI 23.4 ± 4.3 kg/m2）接受 ELVR 后肺功能和运动能力得到改善。39.1%的参与者实现了完全性肺叶塌陷。ELVR 后体重和 BMI 呈非统计学意义的增加（p=0.111 和 p=0.102）。BIA 测量显示相位角、细胞百分比和 ECM/BCM 恶化，即身体成分恶化，但无统计学意义。这主要是由于 ECM、ECW 和 ICW 的统计学显著增加（均 p＜0.001）。
ELVR 并未显示身体成分有任何有益变化，尽管患者体重有增加趋势。需要更大的队列来证实这些发现。
