Catabolic/anabolic balance and muscle wasting in patients with COPD
Catabolic/anabolic balance and muscle wasting in patients with COPD
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DOI：
10.1378/chest.124.1.83
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发表时间：
2003-07-01
期刊：
影响因子：
9.6
通讯作者：
Maltais, F
中科院分区：
文献类型：
--
作者：
Debigaré, R;Marquis, K;Maltais, F
背景：COPD患者肌肉萎缩的机制尚不清楚。本研究旨在评价分解代谢因子循环水平之间的关系（即白细胞介素[IL]-6和皮质醇），合成代谢因子（即生物可利用睾酮[Tbio]、硫酸脱氢表雄酮[DHEAS]和胰岛素样生长因子[IGF]-I）和大腿中部肌肉横截面积（MTCSA）。在45名COPD男性患者（平均[+/- SEM] FEV 1，43 +/- 3%预测值;平均年龄，67 +/- 1岁）和16名年龄相似的久坐健康男性中测量了上述因素的血清水平。使用CT扫描定量MTCSA。根据MTCSA（< 70或大于或等于70 cm（2））将COPD患者分为两组。结果：与对照组相比，COPD患者的性腺功能减退（即Tbio < 2 nmol/L）患病率更高（分别为22%和0%）。与健康受试者相比，MTCSA < 70 cm（2）的患者DHEAS水平显著降低（p < 0.01）。COPD患者两个亚组的IL-6水平均显著高于对照组（p < 0.005）。与对照组相比，MTCSA < 70 cm 2的COPD患者的皮质醇/DHEAS、IL-6/DHEAS、IL-6/Tbio和IL-6/IGF-I比值显著更高（p < 0.05）。与MTCSA大于或等于70 cm（2）的COPD患者相比，MTCSA < 70 cm（2）的COPD患者的皮质醇/DHEAS和IL-6/DHEAS比值也显著更高（p < 0.05）。多元逐步回归分析显示，IL-6/DHEAS比值可解释MTCSA变异的20%（p < 0.005）。结论：COPD患者存在分解代谢/合成代谢紊乱，可能导致COPD向肌萎缩的转变。
Backgroud: The mechanisms leading to muscle wasting in patients with COPD are still uncertain. This study was undertaken to evaluate the relationships among circulating levels of catabolic factors (ie, interleukin [IL]-6 and cortisol), anabolic factors (ie, bioavailable testosterone [Tbio], dehydroepiandrosterone sulfate [DHEAS], and insulin-like growth factor [IGF]-I), and mid-thigh muscle cross-sectional area (MTCSA) in patients with COPD.Methods: Serum levels of the above factors were measured in 45 men with COPD (mean [+/- SEM] FEV1, 43 +/- 3% predicted; mean age, 67 +/- 1 years) and 16 sedentary healthy men of similar age. MTCSA was quantified using CT scanning. Patients with COPD were subdivided into two groups according to the MTCSA (< 70 or greater than or equal to 70 cm(2)).Results: There was a greater prevalence of hypogonadism (ie, Tbio, < 2 nmol/L) in patients with COPD compared to control subjects (22% vs 0%, respectively). Patients with an MTCSA of < 70 cm(2) had significantly reduced levels of DHEAS compared to those in healthy subjects (p < 0.01). IL-6 levels were significantly higher in both subgroups of COPD patients compared to those in control subjects (p < 0.005). The cortisol/DHEAS, IL-6/DHEAS, IL-6/Tbio, and IL-6/IGF-I ratios were significantly greater in COPD patients with an MTCSA of < 70 cm(2) compared to those in control subjects (p < 0.05). The cortisol/DHEAS and IL-6/DHEAS ratios were also significantly greater in COPD patients with an MTCSA of < 70 cm(2) than in COPD patients with an MTCSA of greater than or equal to 70 cm(2) (p < 0.05). In a stepwise multiple regression analysis,the IL-6/DHEAS ratio explained 20% of the variance in MTCSA (p < 0.005).Conclusion: Catabolic/anabolic disturbances were found in COPD patients leading to a shift toward catabolism and possibly to the development of peripheral muscle wasting.