Obesity modulates diaphragm curvature in subjects with and without COPD
Obesity modulates diaphragm curvature in subjects with and without COPD
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DOI：
10.1152/ajpregu.00173.2017
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发表时间：
2017-11-01
影响因子：
2.8
通讯作者：
Sharafkhaneh, Amir
中科院分区：
文献类型：
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作者：
Boriek, Aladin M.;Lopez, Michael A.;Sharafkhaneh, Amir
肥胖是慢性阻塞性肺疾病（COPD）的常见合并症，并与不良结局相关。然而，目前尚不清楚肥胖和COPD之间的相互作用是否调节横膈膜的形状，从而调节其功能。身体质量指数（BMI）已被用作肥胖的相关因素。我们检验了非COPD和COPD受试者膈肌的形状和其插入环的大小受BMI调节的假设。我们招募了48例支气管扩张剂后用力呼气容积（FEV 1）与用力肺活量（FVC）之比< 0.7的COPD患者和29例年龄匹配的吸烟者/既往吸烟者对照（非COPD）受试者，他们接受了胸部计算机断层扫描（CT），肺容量范围从功能残气量（FRC）到总肺容量（TLC）。然后，我们计算了最大主膈肌曲率在肋中部地区的左半膈在吸气结束时，在安静呼吸（EI）和TLC。COPD和非COPD受试者膈肌最大曲率半径均随BMI增加而增加。随着BMI的增加，胸壁膈肌附着环的大小也明显增加。令人惊讶的是，COPD的严重程度似乎并没有引起隔膜形状的显着改变，除了在TLC正常体重的受试者。我们的数据揭示了重要的因素，如BMI，隔膜插入环的大小和疾病严重程度，调节非COPD和COPD受试者的呼吸泵结构。
Obesity is a common comorbidity of chronic obstructive pulmonary disease (COPD) and has been associated with worse outcomes. However, it is unknown whether the interaction between obesity and COPD modulates diaphragm shape and consequently its function. The body mass index (BMI) has been used as a correlate of obesity. We tested the hypothesis that the shape of the diaphragm muscle and size of the ring of its insertion in non-COPD and COPD subjects are modulated by BMI. We recruited 48 COPD patients with postbronchiodilator forced expiratory volume in 1 s (FEV1)-to-forced vital capacity (FVC) < 0.7 and 29 age-matched smoker/exsmoker control (non-COPD) subjects, who underwent chest computed tomography (CT) at lung volumes ranging from functional residual capacity (FRC) to total lung capacity (TLC). We then computed maximum principal diaphragm curvature in the midcostal region of the left hemidiaphragm at the end of inspiration during quiet breathing (EI) and at TLC. The radius of maximum curvature of diaphragm muscle increased with BMI in both COPD and non-COPD subjects. The size of diaphragm ring of insertion on the chest wall also increased significantly with increasing BMI. Surprisingly, COPD severity did not appear to cause significant alteration in diaphragm shape except in normal-weight subjects at TLC. Our data uncovered important factors such as BMI, the size of the diaphragm ring of insertion, and disease severity that modulate the structure of the ventilatory pump in non-COPD and COPD subjects.