重度COPD患者营养风险与运动耐量的相关性研究

Correlation between nutritional risk and exercise tolerance in patients with severe chronic obstructive pulmonary disease

关键词:  营养风险筛查  慢性阻塞性肺疾病  静态常规肺功能检测  心肺运动试验

Key words:  nutritional risk screening  chronic obstructive pulmonary disease  static routine pulmonary functiontest  cardiopulmonary exercise test

摘要:

目的 探讨重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者营养风险与运动耐量的关系。 方法 根据营养风险筛查2002标准(NRS-2002)对58例重度COPD患者进行营养风险评估,分为无营养风险组(A组,n=33)及有营养风险组(B组,n=25)。两组分别进行血气分析(arterial blood gas, ABG)、常规肺功能(pulmonary function test, PFT)及心肺运动试验(cardiopulmonary exercise test, CPET)。 结果 两组间的年龄和身高差异无统计学意义(P＞0.05)。B组体质量及BMI低于A组(P＜0.01)。血气分析中两组间的p_aO₂和p_aCO₂差异无统计学意义(P＞0.05)。肺功能检测B组DLCO显著低于A组(P＜0.05)。而两组间其他指标(FEV₁、FEV₁%pred、FVC、FEV₁/FVC、RV及RV/TLC)差异无统计学意义(P均＞0.05)。心肺运动试验检查B组Peak V· O₂、Peak V· O₂%pred及Peak O₂ pulse显著低于A组(P＜0.05, P＜0.01)。两组间Peak V· O₂/kg及Peak Load差异无统计学意义(P＞0.05)。58例重度COPD患者的NRS评分与Peak V· O₂呈显著负相关(r=-0.353,P＜0.01)。58例重度COPD患者的NRS评分与Peak O₂ pulse、Peak Load呈负相关(r=-0.322、-0.272,P均＜0.05)。 结论 有营养风险的重度COPD患者的肺换气功能减低更显著,运动耐量下降更明显。重度COPD患者的NRS评分可预测其运动耐量。

Abstract:

ObjectiveTo investigate the relationship between nutritional risk and exercise tolerance in patients with severe chronic obstructive pulmonary disease (COPD). Methods The nutritional risk of 58 severe COPD patients was assessmented according to the nutritional risk screening 2002 (NRS-2002). There were 33 patients without nutritional risk (NRS<3, group A) and 25 patients with nutritional risk (NRS≥3, group B). Arterial blood gas (ABG) analysis, pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) were performed in all patients. Results There were no significant differences in age and height between two groups (P>0.05). The weight [(51.24±4.68)kg], BMI (18.34±1.33) in group B were lower than those in group A (P<0.01). There no significant differences in blood gas parameters PaO₂ and PaCO₂ between two groups (P>0.05). Pulmonary function tests showed that the DLCO of group B was significantly lower than that of group A (P<0.01); while there were no significant differences in other indicators (FEV₁, FEV₁%pred, FVC, FEV₁/FVC, RV, RV/TLC) between two groups (P>0.05). In cardiopulmonary exercise test, Peak V· O₂, Peak V· O₂%pred and Peak O₂ pulse in group B were singificantly lower than those in group A (P<0.05 or P<0.01). There were no significant differences in Peak V· O₂/kg and Peak Load between the two groups (P>0.05). NRS score and Peak VO₂ of 58 cases of patients with COPD showed a significant negative correlation (r=-0.353, P<0.01). The NRS score of 58 patients with severe COPD was negatively correlated with Peak O₂ pulse, Peak Load (r=-0.322、0.272, P<0.05). Conclusion The nutritional risk of patients with severe COPD can worsen pulmonary ventilation function and decrease exercise tolerance significantly. Nutritional risk assessment may help to understand the severity of patients with severe COPD and to predict clinical risk.