Sarcopenia in COPD: relationship with COPD severity and prognosis.
Sarcopenia in COPD: relationship with COPD severity and prognosis.
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DOI：
10.1590/s1806-37132015000000040
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Borba VZ
中科院分区：
文献类型：
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作者：
Costa TM;Costa FM;Moreira CA;Rabelo LM;Boguszewski CL;Borba VZ
评估慢性阻塞性肺病患者肌肉减少症的患病率，并确定肌肉减少症是否与慢性阻塞性肺病的严重程度和预后相关。 在我们机构的肺部门诊对慢性阻塞性肺病患者进行了一项横断面研究。患者接受了双能 X 射线吸收测定法。肌肉减少症的诊断是根据骨骼肌指数进行的，该指数仅针对低体重受试者定义为四肢瘦体重/身高2，并根据正常/超重受试者的脂肪量进行调整。疾病严重程度（COPD 阶段）根据慢性阻塞性肺疾病全球倡议 (GOLD) 标准进行评估。阻塞程度和预后由体重指数、气流阻塞、呼吸困难和运动能力（BODE）指数决定。 我们招募了 91 名患者（50 名女性），平均年龄为 67.4 ± 8.7 岁，平均 BMI 为 25.8 ± 6.1 kg/m2。 36 名患者 (39.6%) 出现肌肉减少症，与性别、年龄或吸烟状况无关。肌肉减少症与 GOLD 阶段或 FEV1（用作梗阻程度的指标）无关。患有肌少症的患者的 BMI、体脂百分比和总瘦体重均低于未患肌少症的患者 (p < 0.001)。 BODE 四分位数 3 或 4 的患者中肌肉减少症比 BODE 四分位数 1 或 2 的患者更常见 (p = 0.009)。多变量分析显示，BODE 四分位数与肌少症显着相关，无论年龄、性别、吸烟状况和 GOLD 阶段如何。 在慢性阻塞性肺病患者中，肌肉减少症似乎与身体成分的不利变化和预后不良有关。
To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD. A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index. We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage. In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.