Gosselink R, Troosters T, Decramer M
Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Belgium.
Am J Respir Crit Care Med. 1996 Mar;153(3):976-80. doi: 10.1164/ajrccm.153.3.8630582.
Recently, it was suggested that fatigue of peripheral muscles could contribute to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). In order to quantify the role of peripheral muscle force, we restudied potential determinants of exercise capacity (6-min walking distance [6 MWD] and maximal oxygen consumption [V02max]) in 41 consecutive COPD patients (FEV1, 43 +/- 19% of predicted, TLCO, 56 +/- 25% of predicted) admitted to our pulmonary rehabilitation program. VO2max (incremental cycle ergometer test), 6 MWD (best of three), lung function (FEV1, FVC, TLC, FRC), diffusing capacity (TLCO), isometric quadriceps force (QF), hand grip force (HF), and maximal inspiratory (PImax) and expiratory (PEmax) pressures were measured. Patients had a poor 6 MWD (372 +/- 136 m) and VO2max (1.35 +/- 0.60 L, 71%), reduced respiratory (PImax 65 +/- 27%) and peripheral muscle force (QF 74 +/- 27%, HF 82 +/- 23%). In single regression analysis, significant correlations (r) were found for VO2max and TLCO (0.68), FEV1 (0.64), QF (0.55), HF (0.53), and body weight (0.49). Walking distance was significantly correlated with QF (0.63), HF (0.61), PImax (0.49), and TLCO (0.38). In stepwise multiple regression analysis, the variables significantly contributing to 6 MWD were QF and Plmax. For VO2max, variables significantly contributing were TLCO, QF, and FEV1. We conclude that lung function and peripheral muscle force are important determinants of exercise capacity in COPD.
最近，有人提出外周肌肉疲劳可能导致慢性阻塞性肺疾病（COPD）患者运动受限。为了量化外周肌肉力量的作用，我们对41例连续入住我们肺康复项目的COPD患者（FEV1为预测值的43±19%，TLCO为预测值的56±25%）的运动能力（6分钟步行距离[6MWD]和最大耗氧量[V02max]）的潜在决定因素进行了重新研究。测量了V02max（递增式功率计测试）、6MWD（三次测试中的最佳值）、肺功能（FEV1、FVC、TLC、FRC）、弥散能力（TLCO）、等长股四头肌力量（QF）、握力（HF）以及最大吸气（PImax）和呼气（PEmax）压力。患者的6MWD较差（372±136米），V02max较低（1.35±0.60升，71%），呼吸肌肉力量（PImax为65±27%）和外周肌肉力量降低（QF为74±27%，HF为82±23%）。在单因素回归分析中，发现V02max与TLCO（0.68）、FEV1（0.64）、QF（0.55）、HF（0.53）和体重（0.49）存在显著相关性。步行距离与QF（0.63）、HF（0.61）、PImax（0.49）和TLCO（0.38）显著相关。在逐步多元回归分析中，对6MWD有显著贡献的变量是QF和PImax。对于V02max，有显著贡献的变量是TLCO、QF和FEV1。我们得出结论，肺功能和外周肌肉力量是COPD患者运动能力的重要决定因素。
