Yang T Y, Qumu M S W, Li X P, Wang S Y, He J Z, Yang T
Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity/National Clinical Research Center for Respiratory Diseases/Institute of Respiratory Medicine, Chinese Academy of Medical Sciences/Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2024 Sep 24;104(36):3402-3408. doi: 10.3760/cma.j.cn112137-20240129-00227.
To investigate the correlation of body composition indices with exercise capacity and nutritional status in male chronic obstructive pulmonary disease (COPD) patients. The clinical data of 90 male COPD patients admitted to the Department of Respiratory and Critical Care Medicine of China-Japan Friendship Hospital from January 2021 to September 2022 were retrospectively collected, and the patients were subjected to a pulmonary function test, body composition measurement, 6-minute walking test distance (6MWD) test, and dominant handgrip strength measurement (HGS). The patients were categorized into COPD Global Initiative for COPD (GOLD) grade 1, 2, 3 and 4 groups according to the severity of lung function. Based on the fat-free mass index (FFMI), patients were categorized into a low FFMI group (FFMI<17 kg/m) and a normal FFMI group (FFMI≥17 kg/m). Based on phase angle (PhA), patients were categorized into the low PhA group (PhA<5°) and the normal PhA group (PhA≥5°). Based on 6MWD, patients were divided into impaired endurance group (6MWD<350 m) and normal endurance group (6MWD≥350 m). Differences in body composition indexes, exercise capacity, and nutritional status of patients in different subgroups were compared. A trend test was used to analyze the trend of GOLD grading and body composition indexes. Correlation analysis was used to analyze the correlation of FFMI, PhA, skeletal muscle mass index (SMI), basal metabolic rate (BMR), and visceral fat index (VFI) with 6MWD, HGS, post-diastolic exertional expiratory volume in the first second as a percentage of exertional lung capacity (FEV%pred), and body mass index (BMI). The age of 90 male COPD patients was 66 (59, 71) years. FFMI, PhA, SMI, BMR, VFI, HGS, and 6MWD tended to decrease with increasing GOLD levels (all <0.05). In the low FFMI group (31 cases), PhA [5.0° (4.7°, 5.1°) vs 5.8° (5.6°, 6.3°)], SMI [6.3 (5.3, 6.9)vs 8.3 (7.7, 9.1) kg/m], and BMR [(1 294.5±387.2) vs (1 538.7±207.5) kcal(1 kcal=4.184 kJ)], VFI [(10.0±4.2) grades vs (14.2±3.3) grades], 6MWD [(430.5±90.8) vs (537.2±85.5) m], FEV%pred [(37.8±7.9)% vs (73.7±21.5)%], BMI [(20.2±3.8) vs (25.5±2.9) kg/m] were lower than those in the normal FFMI group (59 cases, all <0.05). In the low PhA group (23 cases), FFMI [(16.7±2.2) vs (19.5±1.5) kg/m], SMI [6.6 (5.9, 7.0) vs 7.3 (7.7, 9.0) kg/m], BMR [(1 251.8±246.2) vs (1 547.5±206.6) kcal], 6MWD [(451.0±47.1) vs (538.3±87.5) m], HGS [(29.6±4.0) vs (36.4±7.2) kg], FEV%pred [(51.2±15.3)% vs (72.9±22.8)%], BMI [(20.9±3.7) vs (25.5±2.8) kg/m] were lower than those of the normal PhA group (67 cases, all <0.05). In the impaired endurance group (21 cases) PhA [5.2° (5.1°, 5.3°) vs 5.8° (5.6°, 6.3°)], FEV%pred [(34.2±15.4)% vs (72.7±22.2)%] were lower than those in the normal endurance group (69 cases, all 0.05). Correlation analysis showed that FFMI was positively correlated with HGS, FEV%pred, and BMI ( values of 0.327, 0.235, and 0.782, all <0.05); PhA was positively correlated with 6MWD, FEV%pred, and BMI ( values of 0.341, 0.258, and 0.251, all <0.05); SMI was positively correlated with HGS and BMI ( values of 0.411 and 0.710, all <0.05); BMR was positively correlated with 6MWD, HGS, FEV%pred, and BMI ( values of 0.338, 0.508, 0.285, and 0.676, all <0.05); VFI was positively correlated with BMI ( value of 0.791, <0.001). FFMI is positively correlated with HGS, FEV%pred, and BMI; PhA is positively correlated with 6MWD, FEV%pred, and BMI; SMI is positively correlated with HGS and BMI; BMR is positively correlated with 6MWD, HGS, FEV%pred, and BMI; VFI is positively correlated with BMI. Body composition indexes may reflect the exercise capacity and nutritional status of male COPD patients.
探讨男性慢性阻塞性肺疾病（COPD）患者身体成分指标与运动能力及营养状况的相关性。回顾性收集2021年1月至2022年9月在中国-日本友好医院呼吸与危重症医学科住院的90例男性COPD患者的临床资料，对患者进行肺功能测试、身体成分测量、6分钟步行试验距离（6MWD）测试和优势手握力测量（HGS）。根据肺功能严重程度将患者分为慢性阻塞性肺疾病全球倡议组织（GOLD）1、2、3和4级组。基于去脂体重指数（FFMI），将患者分为低FFMI组（FFMI<17 kg/m）和正常FFMI组（FFMI≥17 kg/m）。基于相位角（PhA），将患者分为低PhA组（PhA<5°）和正常PhA组（PhA≥5°）。基于6MWD，将患者分为耐力受损组（6MWD<350 m）和正常耐力组（6MWD≥350 m）。比较不同亚组患者的身体成分指标、运动能力和营养状况差异。采用趋势检验分析GOLD分级与身体成分指标的趋势。采用相关性分析分析FFMI、PhA、骨骼肌质量指数（SMI）、基础代谢率（BMR）和内脏脂肪指数（VFI）与6MWD、HGS、用力后第1秒舒张期呼气量占用力肺活量的百分比（FEV%pred）和体重指数（BMI）的相关性。90例男性COPD患者的年龄为66（59，71）岁。FFMI、PhA、SMI、BMR、VFI、HGS和6MWD随GOLD水平升高而降低（均P<0.05）。低FFMI组（31例）的PhA[5.0°（4.7°，5.1°）比5.8°（5.6°，6.3°）]、SMI[6.3（5.3，6.9）比8.3（7.7，9.1）kg/m]、BMR[（1 294.5±387.2）比（1 538.7±207.5）kcal（1 kcal = 4.184 kJ）]、VFI[（10.0±4.2）级比（14.2±3.3）级]、6MWD[（430.5±90.8）比（537.2±85.5）m]、FEV%pred[（37.8±7.9）%比（73.7±21.5）%]、BMI[（20.2±3.8）比（25.5±2.9）kg/m]低于正常FFMI组（59例，均P<0.05）。低PhA组（23例）的FFMI[（16.7±2.2）比（19.5±1.5）kg/m]、SMI[6.6（5.9，7.0）比7.3（7.7，9.0）kg/m]、BMR[（1 251.8±246.2）比（1 547.5±206.6）kcal]、6MWD[（451.0±47.1）比（538.3±87.5）m]、HGS[（29.6±4.0）比（36.4±7.2）kg]、FEV%pred[（51.2±15.3）%比（72.9±22.8）%]、BMI[（20.9±3.7）比（25.5±2.8）kg/m]低于正常PhA组（67例，均P<0.05）。耐力受损组（21例）的PhA[5.2°（5.1°，5.3°）比5.8°（5.6°，6.3°）]、FEV%pred[（34.2±15.4）%比（72.7±22.2）%]低于正常耐力组（69例，均P<0.05）。相关性分析显示，FFMI与HGS、FEV%pred和BMI呈正相关（r值分别为0.327、0.235和0.782，均P<0.05）；PhA与6MWD、FEV%pred和BMI呈正相关（r值分别为0.341、0.258和0.251，均P<0.05）；SMI与HGS和BMI呈正相关（r值分别为0.411和0.710，均P<0.05）；BMR与6MWD、HGS、FEV%pred和BMI呈正相关（r值分别为0.338、0.508、0.285和0.676，均P<0.05）；VFI与BMI呈正相关（r值为0.791，P<0.001）。FFMI与HGS、FEV%pred和BMI呈正相关；PhA与6MWD、FEV%pred和BMI呈正相关；SMI与HGS和BMI呈正相关；BMR与6MWD、HGS、FEV%pred和BMI呈正相关；VFI与BMI呈正相关。身体成分指标可反映男性COPD患者的运动能力和营养状况。
