Effect of Pulmonary Rehabilitation on Erector Spinae Muscles in Individuals With COPD
Effect of Pulmonary Rehabilitation on Erector Spinae Muscles in Individuals With COPD
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DOI：
10.4187/respcare.08678
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发表时间：
2021-09-01
期刊：
影响因子：
2.5
通讯作者：
Fukuda, Kanji
中科院分区：
文献类型：
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作者：
Higashimoto, Yuji;Shiraishi, Masashi;Fukuda, Kanji
背景技术背景：最近的一篇论文报道，竖脊肌（ESM）的低肌肉质量与COPD受试者的预后不良和肌肉质量随时间下降密切相关。然而，肺康复（PR）的影响，如果有的话，对ESM质量还没有报道。我们假设PR减少了ESM质量的年度下降。方法：这是一项回顾性队列研究。评估了39例接受PR并在PR前后接受胸部计算机断层扫描的COPD受试者（康复组）。我们还评估了39名年龄匹配的COPD患者，他们没有接受PR（非康复组）。从2010年8月至2020年3月收集了两组的数据。使用轴向计算机断层扫描图像测量ESM横截面积（ESMCSA），并计算年度变化。在PR前后测量6分钟步行距离（6 MWD）;最小临床重要差异定义为30 m。研究结果：非康复组的ESMCSA随时间推移而下降（-116.0 +/- 141.2 mm（2）/y），但PR组增加（51.0 +/- 95.3 mm（2）/y; P <0.001）。与康复组中无应答者相比，6 MWD增加超过最小临床重要差异的受试者中ESMCSA的年增加显著更高。ESMCSA的年变化与合并症指数呈负相关，三联疗法（长效β 2受体激动剂/长效毒蕈碱拮抗剂/吸入性皮质类固醇）对ESMCSA的年变化有有利影响。多元回归分析显示，只有PR是ESMCSA年度变化的独立因素。结论：在COPD受试者中，ESM质量每年下降。PR减少了肌肉质量的年度下降。
BACKGROUND: A recent paper reported that low muscle mass in the erector spinae muscles (ESM) was strongly associated with poor prognosis and declining muscle mass over time in subjects with COPD. However, effects of pulmonary rehabilitation (PR), if any, on ESM mass have not been reported. We hypothesized that PR reduces the annual decline in ESM mass. METHODS: This was a retrospective cohort study. Thirty-nine subjects with COPD who received PR and underwent chest computed tomography before and after PR were evaluated (rehabilitation group). We also evaluated 39 age-matched subjects with COPD who did not receive PR (nonrehabilitation group). Data were collected from August 2010 until March 2020 in both groups. The ESM cross-sectional area (ESMCSA) was measured using axial computed tomography images, and annual changes were calculated. The 6-min walk distance (6MWD) was measured before and after PR; the minimum clinically important difference was defined as 30 m. RESULTS: ESMCSA declined in the nonrehabilitation group over time (-116.0 +/- 141.2 mm(2)/y) but increased in the PR group (51.0 +/- 95.3 mm(2)/y; P < .001). The annual increase in ESMCSA was significantly higher among subjects with an increase in 6MWD that exceeded the minimum clinically important difference compared with nonresponders in the rehabilitation group. The annual change in ESMCSA was negatively correlated with comorbidity index, and triple therapy (long-acting beta(2)-agonist/long-acting muscarinic antagonist/inhaled corticosteroid) had a favorable effect on annual change in ESMCSA. Multiple regression analysis revealed that only PR was an independent factor for annual change in ESMCSA. CONCLUSIONS: ESM mass was shown to decline yearly in subjects with COPD. The annual decline in muscle mass was reduced by PR.