Creutzberg E C, Schols A M, Bothmer-Quaedvlieg F C, Wouters E F
Department of Pulmonology, University Hospital Maastricht, The Netherlands.
Eur J Clin Nutr. 1998 Jun;52(6):396-401. doi: 10.1038/sj.ejcn.1600571.
This study describes the prevalence and characteristics of an elevated resting energy expenditure (REE) in patients with chronic obstructive pulmonary disease (COPD).
Patients were consecutively admitted to an in-patient pulmonary rehabilitation centre.
The study group consisted of 172 (123 males) clinically stable patients with COPD, age mean (s.d.) 64(10) y).
REE was assessed by indirect calorimetry (ventilated hood) and adjusted for the influence of fat-free mass (FFM; measured by bioelectrical impedance analysis) using the linear regression equations of REE on FFM generated in 92 healthy age-matched subjects (58 males, age 67(8) y) for men and women separately. The predicted REE adjusted for FFM (REEFFM) was obtained by using the FFM of each individual patient in the linear regression equation of REE on FFM generated in the healthy control group.
26% of the patients were hypermetabolic (defined as REE > 110% REEFFM), characterized by a lower age (60 (10) vs 65 (9) y) and a lower total lung capacity (TLC; 122(27)vs 139(28) %pred) compared to normometabolic patients (P < 0.001). The prevalence of FFM-depletion was equal among normo- and hypermetabolic patients: 36% vs 33% respectively. Depleted patients expressed however a significantly higher residual volume/TLC ratio and a lower maximal inspiratory mouth pressure independently of hypermetabolism (P < 0.05). In contrast, on base of the Harris & Benedict (HB) prediction equations, which do not take body composition into account, 54% of the patients were hypermetabolic (REE > 110% REEHB), characterized by a higher age and a lower body mass and FFM (P < 0.05).
Hypermetabolism commonly occurs in COPD, characterized by less hyperinflation at rest, in contrast to the suggested contribution of an elevated oxygen cost of breathing (OCB) to hypermetabolism in COPD. The higher hyperinflation at rest in FFM-depleted patients independently of hypermetabolism suggests a higher OCB during activities, contributing to the elevated total daily energy expenditure previously reported in COPD. The HB-equations overestimate the prevalence of hypermetabolism and link hypermetabolism incorrectly to aging and depletion.
本研究描述慢性阻塞性肺疾病（COPD）患者静息能量消耗（REE）升高的患病率及特征。
患者连续入住一家住院肺康复中心。
研究组由172例（123例男性）临床稳定的COPD患者组成，年龄平均（标准差）为64（10）岁。
通过间接测热法（通气面罩）评估REE，并使用92例年龄匹配的健康受试者（58例男性，年龄67（8）岁）分别针对男性和女性生成的REE与去脂体重（FFM；通过生物电阻抗分析测量）的线性回归方程，对FFM的影响进行校正。通过将每位患者的FFM代入健康对照组生成的REE与FFM的线性回归方程中，获得校正FFM后的预测REE（REEFFM）。
26%的患者为高代谢（定义为REE>110%REEFFM），其特征为与代谢正常的患者相比年龄较小（60（10）岁对65（9）岁）且肺总量（TLC）较低（122（27）%预计值对139（28）%预计值）（P<0.001）。FFM耗竭在代谢正常和高代谢患者中的患病率相同：分别为36%和33%。然而，无论是否存在高代谢，耗竭患者的残气量/TLC比值均显著更高，最大吸气口腔压力更低（P<0.05）。相比之下，基于未考虑身体成分的哈里斯-本尼迪克特（HB）预测方程，54%的患者为高代谢（REE>110%REEHB），其特征为年龄较大、体重和FFM较低（P<0.05）。
高代谢在COPD中常见，其特征为静息时肺过度充气较少，这与呼吸氧耗（OCB）升高对COPD高代谢的影响的观点相反。无论是否存在高代谢，FFM耗竭患者静息时较高的肺过度充气表明活动期间OCB较高，这导致了先前报道的COPD患者每日总能量消耗升高。HB方程高估了高代谢的患病率，并错误地将高代谢与衰老和耗竭联系起来。
