慢性阻塞性肺疾病患者身體成分與心肺運動能力的相關性研究

于春艷 董芬 雷潔萍 楊汀 夏金根 曲木詩瑋 楊天祎 李曉盼

基金項目：中國醫學科學院醫學與健康科技創新工程（2021-12M-1-049）

引用本文：于春艷，董芬，雷潔萍，等. 慢性阻塞性肺疾病患者身體成分與心肺運動能力的相關性研究［J］. 中國全科醫學，2024，27（29）：3629-3634. DOI：10.12114/j.issn.1007-9572.2024.0095. ［www.chinagp.net］

YU C Y，DONG F，LEI J P，et al. Correlation between body composition and cardiopulmonary exercise capacity in patients with chronic obstructive pulmonary disease［J］. Chinese General Practice，2024，27（29）：3629-3634.

? Editorial Office of Chinese General Practice. This is an open access article under the CC BY-NC-ND 4.0 license.

【摘要】 背景 心肺運動試驗（CPET）對于評估慢性阻塞性肺疾病（COPD）患者最大運動能力以及制訂康復處方有著至關重要的作用。有研究表明，身體成分與CPET結果相關。CPET操作復雜、耗時長、禁忌證較多且風險大，一些COPD患者無法完成，而身體成分分析操作簡單快捷。目的 探討COPD患者的身體成分與CPET的相關性，為不能完成CPET的COPD患者預測最大運動能力、制訂康復處方、合理營養支持提供依據。方法 回顧性選取2021年7月—2022年3月于中日友好醫院進行身體成分檢測和CPET檢測的穩定期COPD患者77例，依次進行身體成分測定和負荷連續遞增的CPET，評估身體成分和CPET結果的關系。結果 77例符合要求的穩定期COPD患者均完成了身體成分測定和CPET。相關性分析結果顯示，體脂率（BFP）與最高運動狀態時代謝當量（peakMETs）呈負相關（P<0.01）；骨骼肌質量指數（SMI）與最高運動狀態時攝氧量（peakVO2）、最高運動狀態時運動負荷（peakLoad）、最大分鐘通氣量（peakVE）、最高運動狀態時心率（peakHR）、最高運動狀態時氧脈搏（peakO2pulse）、攝氧效率斜率（OUES）呈正相關（P<0.01）；去脂體質量指數（FFMI）與peakVO2、peakLoad、peakVE、peakO2pulse、OUES呈正相關（P<0.01）。多元線性回歸分析結果顯示，SMI、FFMI與COPD患者peakLoad、peakVE、peakO2pulse、OUES呈獨立正相關（P<0.05）；BFP與COPD患者peakMETs呈獨立負相關（P<0.05）。其中在因變量為peakLoad、peakVE、peakO2pulse、OUES的多元線性回歸分析中，SMI的β值高于FFMI。結論 肌肉含量與COPD患者的運動能力呈正相關，身體成分測定結果可以作為COPD患者運動能力預測、指導康復運動、合理營養支持治療的重要標準。

【關鍵詞】 慢性阻塞性肺疾病；心肺運動試驗；身體成分；康復；多元線性回歸

【中圖分類號】 R 563.9 【文獻標識碼】 A DOI：10.12114/j.issn.1007-9572.2024.0095

Correlation between Body Composition and Cardiopulmonary Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease

YU Chunyan1，2，DONG Fen3，LEI Jieping3，YANG Ting1，2*，XIA Jingen2，QUMU Shiwei2，YANG Tianyi4，LI Xiaopan2

1.Department of Pulmonary and Critical Care Medicine，Peking University China-Japan Friendship School of Clinical Medicine，Beijing 100191，China

2.National Center for Respiratory Medicine/State Key Laboratory of Respiratory Health and Multimorbidity/National Clinical Research Center for Respiratory Diseases/Institute of Respiratory Medicine，Chinese Academy of Medical Sciences/Department of Pulmonary and Critical Care Medicine，Center of Respiratory Medicine，China-Japan Friendship Hospital，Beijing 100029，China

3.National Center for Respiratory Medicine/State Key Laboratory of Respiratory Health and Multimorbidity/National Clinical Research Center for Respiratory Diseases/Institute of Respiratory Medicine，Chinese Academy of Medical Sciences/Research Programs and Data Management Department，Center of Respiratory Medicine，China-Japan Friendship Hospital，Beijing 100029，China

4.Department of Rehabilitation Medicine，China-Japan Friendship Hospital，Beijing 100029，China

*Corresponding author：YANG Ting，Chief physician/Doctoral supervisor；E-mail：zryyyangting@163.com

【Abstract】 Background Cardiopulmonary exercise testing（CPET） is essential for assessing the maximal exercise capacity of patients with chronic obstructive pulmonary disease（COPD） and for developing rehabilitation prescriptions. Body composition has been shown to be associated with CPET results，which is complex，time-consuming，contraindicated，and risky，and cannot be performed in some COPD patients，whereas body composition analysis is simple and fast. Objective This paper focuses on the correlation between body composition and CPET in patients with COPD，and provides a basis for predicting maximal exercise capacity，formulating rehabilitation prescriptions，and rational nutritional support for patients with COPD who are unable to complete cardiopulmonary exercise testing. Methods Stable COPD patients were enrolled in the outpatient respiratory clinic of China-Japan Friendship Hospital between July 2021 and March 2022，and were sequentially subjected to body composition measurements and CPET with continuous incremental loading，and the test results were analyzed to assess the relationship between body composition and CPET results，and to analyze the value of the body composition indexes in predicting the results of CPET. Results Seventy-seven eligible patients with stable COPD completed body composition measurement and exercise cardiopulmonary exercise testing. Correlation analysis showed that body fat percentage（BFP） was negatively correlated with peak metabolic equivalents（peakMETs）（P<0.01）；skeletal muscle mass index（SMI） was positively correlated with peak oxygen uptake（peakVO2），peak load，peak ventilation volume（peakVE），maximum heart rate（peakHR），peak oxygen pulse（peakO2pulse），and oxygen uptake efficiency slope（OUES） at the highest exercise state were positively correlated（P<0.01）；and the fat free mass index（FFMI）was positively correlated with peakVO2，peakLoad，peakVE，peakO2pulse，and OUES（P<0.01）. The results of multivariable linear regression analysis showed that SMI and FFMI were independently and positively correlated with peakLoad，peakVE，peakO2pulse，and OUES in patients with COPD（P<0.05）. BFP was independently and negatively correlated with peakMETs in patients with COPD（P<0.05）. SMI had better predictive ability than FFMI for the results of the CPET trial in COPD patients peakLoad，peakVE，peakO2pulse，and OUES. Conclusion Muscle content is positively correlated with the exercise capacity of COPD patients，and the results of body composition measurement can be used as an important criterion for predicting the exercise capacity of COPD patients，guiding the rehabilitation exercise and rational nutritional support therapy.

【Key words】 Chronic obstructive pulmonary disease；Cardiopulmonary exercise test；Body composition；Rehabilitation；Multifactor linear regression

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是以持續存在氣流受限為特征的可以預防和治療的疾病，病情呈漸進性進展［1］。此病常年反復發作，嚴重影響患者的生活質量和勞動能力。COPD穩定期患者的治療，現有措施仍以支氣管擴張、祛痰和長期家庭氧療為主，但效果不能滿足患者日常生活需求［2］。……