Terada Satoru, Tanabe Naoya, Maetani Tomoki, Shiraishi Yusuke, Terada Kunihiko, Shima Hiroshi, Oguma Tsuyoshi, Sakamoto Ryo, Kanasaki Megumi, Masuda Izuru, Sato Atsuyasu, Sato Susumu, Hirai Toyohiro
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Respiratory Medicine and General Practice, Terada Clinic, Hyogo, Japan.
Respir Res. 2025 Apr 13;26(1):143. doi: 10.1186/s12931-025-03211-y.
Low body mass index (BMI) is a prognostic factor, and skeletal muscle adiposity may affect mortality irrespective of BMI in patients with chronic obstructive pulmonary disease (COPD). However, the association between muscle adiposity and healthy life expectancy in normal-weight patients remains unestablished.
To examine whether lower chest computed tomography (CT)-assessed erector spinae muscle density (ESMD), which represents antigravity muscle adiposity, is associated with subsequent loss of health-related independence in normal-weight patients with COPD.
The ESMD lower limit of normal (LLN) was determined in 194 healthy subjects undergoing lung cancer screening CT. In a prospective cohort of patients with COPD undergoing baseline inspiratory/expiratory CT, the onset of loss of health-related independence, requiring long-term nursing facility or home nursing/medical care, was recorded over 5 years.
Smokers with COPD (n = 199) were divided into 4 groups on the basis of BMI and the ESMD-LLN: underweight (n = 22), normal-weight with (n = 40) and without (n = 81) low ESMD, and overweight (n = 56). Greater airway wall thickening was associated with BMI-independent low ESMD. A multivariable Cox proportional hazards model including only normal-weight patients with COPD (n = 121) indicated that low ESMD was independently associated with a higher loss-of-independence rate after adjusting for FEV, COPD assessment test score, and a smaller cross-sectional area of erector spinae muscles (hazard ratio [95% confidence interval] = 3.21 [1.30-7.89]).
Low antigravity muscle density could reflect airway wall thickening and shorten healthy life expectancy in normal-weight patients with COPD.
低体重指数（BMI）是一种预后因素，在慢性阻塞性肺疾病（COPD）患者中，骨骼肌脂肪含量可能会影响死亡率，而与BMI无关。然而，正常体重患者的肌肉脂肪含量与健康预期寿命之间的关联尚未确立。
探讨通过胸部计算机断层扫描（CT）评估的竖脊肌密度（ESMD）降低（代表抗重力肌脂肪含量）是否与正常体重的COPD患者随后丧失与健康相关的独立性有关。
在194名接受肺癌筛查CT的健康受试者中确定ESMD的正常下限（LLN）。在一个接受基线吸气/呼气CT的COPD患者前瞻性队列中，记录5年内出现需要长期护理机构或家庭护理/医疗护理的与健康相关独立性丧失的情况。
患有COPD的吸烟者（n = 199）根据BMI和ESMD-LLN分为4组：体重过轻（n = 22）、正常体重且ESMD低（n = 40）和ESMD不低（n = 81），以及超重（n = 56）。气道壁增厚与BMI无关的低ESMD相关。一个仅包括正常体重的COPD患者（n = 121）的多变量Cox比例风险模型表明，在调整了第1秒用力呼气容积（FEV）、COPD评估测试评分和竖脊肌较小的横截面积后，低ESMD与更高的独立性丧失率独立相关（风险比[95%置信区间]= 3.21 [1.30 - 7.89]）。
抗重力肌密度低可能反映气道壁增厚，并缩短正常体重的COPD患者的健康预期寿命。
