不同营养状态下慢性阻塞性肺疾病患者临床特征分析

目的探讨不同营养状态下慢性阻塞性肺疾病（COPD）患者是否存在不同的临床特征。方法将病情稳定的COPD患者548例,按身体质量指数（BMI）（体重/身高）进行分组：A组（〈18.5kg/m2）,B组（18.5～23.9kg/m2）,C组（≥24.0kg/m2）。并进行一般情况比较,呼吸困难指数评定,动脉血气分析,肺功能检测,测定白蛋白（Alb）、红细胞压积（HCT）、C反应蛋白（CRP）,评价右心功能。出院后随访观察1年,记录1年中住院次数、住院天数、1年后6min的步行距离、CAT评分。结果 C组女性患者比例多于A组和B组,差异有统计学意义（P〈0.05）。C组FEV1%pred（50.36±16.16）、KCO（78.98±65.43）高于A组（40.45±13.46、38.65±21.76）,A组RV/TLC（140.74±31.67）高于C组（124.38±29.03）,A组CAT评分（19.20±5.24）高于C组（16.87±6.87）,差异均有统计学意义（P〈0.05）。3组在呼吸困难指数、呼吸衰竭发生率、Hct、CRP、右心功能不全发生率差异均无统计学意义（P〈0.05）。3组出院后1年中住院次数、住院天数、1年后6min的步行距离差异均无统计学意义（P〈0.05）。结论 COPD在不同营养状态下存在不同临床特征,营养状态差的患者肺功能、生活质量相对降低明显,不同营养状态COPD其性别构成有差异。

Analysis on clinical feature of patients with chronic obstructive pulmonary disease in different nutritional status

Objective To investigate whether there is different clinical feature in patients with chronic obstructive pulmonary disease (COPD) in different nutritional status. Methods 548 patients with stable COPD were divided into three groups based on body mass index (BMI) (weight/height):less than 18.5 kg/m2 for the group A,18.5-23.9 kg/m2 for the group B,more than 24.0 kg/m2 for the group C. The contrast of general condition,evaluation of dyspnea score and right heart function,arterial blood gas analysis,pulmonary function test were performed,albumin (Alb),hematocrit (Hct) and c-reactive protein (CRP) were tested. After discharge a year follow-up,recording times of hospitalizations,days in hospital,6 minutes walking test,CAT score. Results The percentage of female patients was more in group C than in group A and B,the difference was statistically significant (P<0.05). FEV1%pred and KCO was higher in group C (50.36±16.16,78.98±65.43)than in group A(40.45±13.46,38.65±21.76),RV/TLC was higher in group A (140.74±31.67) than in group C(124.38±29.03),CAT score was higher in group A (19.20±5.24) than in group C (16.87±6.87)(P<0.05).No statistical significance was found in dyspnea score,respiratory failure incidence,Hct,CRP,right cardiac dysfunction incidence,times of hospitalizations,days in hospital and 6 minutes walking test among three groups (P<0.05). Conclusions COPD with different nutritional status may be have different clinical manifestations. Pulmonary function and the quality of life decreased obviously in COPD with poor nutritional status,and there is difference in gender composition.