肌少症对老年慢性阻塞性肺疾病患者生活质量及活动能力的影响

doi:10.16138/j.1673-6087.2023.06.002

摘要/Abstract

摘要：

目的：观察稳定期老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者肌少症的状况，并探讨其对COPD患者生活质量及活动能力的影响。方法：选取我院老年病科2019年7月至2021年4月稳定期COPD患者92例，根据亚洲肌少症诊断标准分为肌少症组32例和非肌少症组60例。收集一般临床资料，所有患者完成肺功能检查、握力及6 m步速试验，用人体成分分析仪测定四肢骨骼肌量，并计算四肢骨骼肌质量指数（skeletal muscle mass index，SMI），用改良版英国医学研究会（modified British Medical Research Council，mMRC）呼吸困难量表及COPD评估测试（COPD assessment test，CAT）评估患者呼吸困难症状。使用Pearson法或Spearman法分析骨骼肌评估指标与COPD疾病评估指标的相关性。采用多元逐步Logistic回归分析COPD合并肌少症对活动能力的影响。结果：COPD患者中肌少症的发生率为34.8%。与非肌少症组相比，肌少症组患者年龄较大（P<0.05），血红蛋白、白蛋白、体质量指数（body mass index，BMI）、握力、6 m步速、四肢骨骼肌量、SMI均显著下降（均P<0.01）。CAT 评分、mMRC 问卷评分高于非肌少症组（均P<0.05）。2组BMI与第1秒用力呼气容积占预计值百分比（percentage of predicted forced expiratory volume in one second, FEV₁%）（r=0.376，P=0.031）、6 m步速（r=0.436，P=0.015）呈正相关，与mMRC（r=-0.340，P=0.032）、CAT呈负相关（r=-0.354，P=0.043）。Logistic回归分析在校正混杂因素后，SMI是COPD患者生活质量及身体活动能力下降的独立危险因素（P<0.05）。结论：肌少症是老年COPD患者常见并发症，且会导致患者生活质量及活动能力下降。

关键词: 老年人, 慢性阻塞性肺疾病, 肌少症, 生活质量及活动能力

Abstract:

Objective To observe the status of sarcopenia in elderly patients with stable chronic obstructive pulmonary disease(COPD), and to explore its effect on quality of life and mobility in COPD patients. Methods A total of 92 patients with stable COPD in the Department of Geriatrics of Ruijin Hospital from July 2019 to April 2021 were selected and divided into sarcopenia group(n=32) and non-sarcopenia group(n=60) according to the Asian diagnostic criteria for sarcopenia. General clinical data were collected. All patients completed the pulmonary function test, grip strength and 6-meter walking speed measurement. The body composition analyzer was used to measure appendicular skeletal muscle (ASM), and the limb skeletal muscle mass index(SMI) was calculated. Symptoms of dyspnea were assessed by modified Medical Research Council Scal (mMRC) and the COPD assessment test (CAT). Pearson’s method or Spearman’s method was used to analyze the correlation between skeletal muscle assessment indexes and COPD disease assessment indexes. Multivariate stepwise Logistic regression was used to analyze the effect on mobility in the COPD patients with sarcopenia. Results The incidence of sarcopenia in the COPD patients was 34.8%. Compared with the non-sarcopenia group, the patients in the sarcopenia group were older (P<0.05), and the hemoglobin, albumin, body mass index (BMI), grip strength, 6-meter walking speed, ASM and SMI were significantly lower(P<0.01). CAT score and mMRC questionnaire score were higher than those in the non-sarcopenia group (P<0.05). BMI was positively correlated with first second forced end-expiratory volume as a percentage of estimated value（FEV₁%）(r=0.376, P=0.031） and 6-meter walking speed（r=0.436, P=0.015） in both groups, and negatively correlated with mMRC（r=-0.340, P=0.032） and CAT （r=-0.354, P=0.043）. Logistic regression analysis showed that SMI was an independent risk factor for decreased quality of life and mobility in the COPD patients after adjusting for confounding factors (P<0.05). Conclusions Sarcopenia is a common complication in elderly patients with COPD and is associated with decreased quality of life and mobility.

Key words: Aged, Chronic obstructive pulmonary disease, Sarcopenia, Quality of life and mobility

中图分类号:

R733.71

赵雅洁, 何清, 徐志红. 肌少症对老年慢性阻塞性肺疾病患者生活质量及活动能力的影响[J]. 内科理论与实践, 2023, 18(06): 383-387.

ZHAO Yajie, HE Qing, XU Zhihong. Impact of sarcopenia on quality of life and mobility in elderly patients with chronic obstructive pulmonary disease[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(06): 383-387.

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指标	非肌少症组（n=60）	肌少症组（n=32）	t/χ²	P
年龄（岁）	77.1±5.2	82.6±7.3	2.567	0.026
男性[n(%)]	49（81.7）	28（87.5）	0.520	0.471
白细胞计数（×10⁹/L）	6.2±1.6	6.0±1.4	0.609	0.544
血红蛋白（g/L）	126.9±14.5	114.6±13.9	4.087	0.002
白蛋白（g/L）	38.7±3.4	34.6±3.5	5.470	0.009
尿酸（μmol/L）	332.6±51.0	334.2±51.1	0.053	0.948
肌酐（μmol/L）	76.4±10.9	80.9±11.5	0.860	0.552
总胆固醇（mmol/L）	4.1±0.9	4.3±1.1	1.905	0.058
甘油三酯（mmol/L）	1.4±0.7	1.6±0.9	1.825	0.069
血清钾（mmol/L）	3.7±0.5	3.8±0.4	0.657	0.624
血清钠（mmol/L）	136.2±6.9	137.4±5.4	0.442	0.644
血清钙（mmol/L）	2.1±0.1	2.2±0.1	1.761	0.081
FEV₁%	58.8±21.9	52.7±17.5	1.840	0.680
FVC%	83.4±21.2	81.9±18.6	0.446	0.656
FEV₁/FVC（%）	54.8±11.1	50.4±10.2	2.465	0.150
GOLD 1级[n（%）]	4（6.7）	1（3.1）	0.517	0.772
GOLD 2级[n（%）]	54（90）	30（93.8）
GOLD 3级[n（%）]	2（3.3）	1（3.1）
LABA/LAMA[n（%）]	10（16.7）	3（9.4）	1.571	0.456
ICS/LABA[n（%）]	46（76.7）	28（87.5）
ICS/LABA/LAMA[n（%）]	4（6.7）	1（3.1）
BMI（kg/m²）	25.4±3.0	20.2±2.2	8.853	0.006
ASM（kg）	23.4±2.5	18.7±2.5	14.846	0.005
SMI（kg/m²）	8.0±0.6	5.6±0.5	17.868	0.004
握力（kg）	29.7±3.0	21.0±5.4	9.638	0.006
mMRC评分（分）	0.9±0.7	1.4±1.0	8.729	0.013
CAT评分（分）	8.4±4.3	11.7±4.4	5.131	0.008
6 m步速（m/s）	1.1±0.2	0.7±0.2	4.286	0.006

指标	FEV₁%		FVC%		FEV₁/FVC		mMRC		CAT		6 m步速
指标	r	P	r	P	r	P	r	P	r	P	r	P
非肌少症组
BMI	0.376	0.031	0.894	0.388	0.056	0.716	-0.340	0.032	-0.354	0.043	0.436	0.015
SMI	0.365	0.037	0.075	0.629	0.003	0.894	-0.262	0.023	-0.367	0.036	0.392	0.024
握力	0.094	0.541	0.056	0.716	0.293	0.110	-0.327	0.064	-0.316	0.073	0.319	0.071
肌少症组
BMI	0.257	0.026	0.619	0.071	0.225	0.162	-0.293	0.010	-0.306	0.004	0.93	0.001
SMI	0.696	0.004	0.193	0.199	0.760	0.002	-0.645	0.002	-0.594	0.003	0.86	0.002
握力	0.343	0.020	0.541	0.438	0.359	0.040	-0.524	0.003	-0.571	0.018	0.329	0.062

因素	mMRC			CAT			6 m步速
因素	OR	95%CI	P	OR	95%CI	P	OR	95%CI	P
年龄	0.973	0.869，1.092	0.726	0.978	0.870，1.102	0.691	0.914	0.831，1.062	0.738
血红蛋白	1.117	0.512，2.438	0.783	0.991	0.915，1.097	0.527	1.015	0.485，1.629	0.503
白蛋白	1.146	0.899，1.303	0.095	1.133	0.882，1.324	0.101	1.193	0.953，1.997	0.072
FEV₁	0.971	0.862，1.086	0.874	0.984	0.857，1.121	0.933	1.077	0.857，1.592	0.394
FVC%	0.936	0.829，1.341	0.939	0.949	0.856，1.381	0.273	1.136	0.931，2.018	0.483
FEV₁/FVC	0.201	0.006，4.329	0.302	0.198	0.007，4.297	0.192	1.094	0.873，1.615	0.442
BMI	0.316	0.061，1.172	0.109	0.526	0.091，1.212	0.825	3.875	1.973，5.148	0.017
握力	1.501	0.919，2.433	0.121	1.442	0.927，2.252	0.098	1.069	0.775，1.865	0.089
SMI	0.169	0.066，0.479	0.002	0.173	0.059，0.437	0.002	4.017	2.174，5.992	0.011