身体成分和肌肉减少症对慢性阻塞性肺疾病患者预后的评估价值

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摘要目的评估身体成分和肌肉减少症对慢性阻塞性肺疾病(COPD)患者预后的评估价值。方法纳入 2021 年 6 月至 2022 年 6 月就诊于南通市肿瘤医院的 COPD 患者共计 185 例。随访为期 1 年,记录患者生存情况。所有患者临床信息基线数据均于入院时检测并记录。一般资料包括年龄、性别、体质指数,以及高血压、糖尿病患病情况。身体成分指标包括腰围、相位角、上臂围、小腿围。结果纳入的 185 例患者中,有 16 例患者死亡,占 8. 6%。依照是否死亡进行分组,分为存活组(169 例)、死亡组(16 例)结果显示,死亡组患者年龄、肌肉减少症发生率明显高于存活组,而相位角明显低于存活组患者,差异有统计学意义(P<0. 05)。 Cox 比例风险模型结果显示,低龄与 COPD 患者死亡风险降低存在明显相关性(HR = 0. 832, 95%CI = 0. 706~ 0. 982,P= 0. 030)。肌肉减少症与 COPD 患者死亡风险增加存在明显相关性(HR= 3. 377, 95%CI = 1. 126~ 10. 130,P= 0. 030)。相位角降低与 COPD 患者死亡风险增加存在明显相关性(HR= 2. 746, 95%CI = 1. 165~ 6. 472,P= 0. 021)。受试者操作特征(ROC)曲线结果显示,年龄预测 COPD 预后的曲线下面积(AUC) 为 0. 814,最大约登指数为 0. 546,对应敏感度为 88. 2%,特异度为 66. 4%。肌肉减少症预测 COPD 预后的 AUC 为 0. 780,最大约登指数为 0. 417,对应敏感度为 64. 7%,特异度为 77. 0%。相位角预测 COPD 预后的 AUC 为 0. 850,最大约登指数为 0. 612,对应敏感度为 88. 2%,特异度为 73. 0%。结论相位角降低和患肌肉减少症均与 COPD 患者死亡发生风险增加存在相关性。相位角降低和患肌肉减少症对 COPD 患者预后有较高的预测价值。

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关键词 ：身体成分, 小腿围, 肌肉减少症, 慢性阻塞性肺疾病, 预后, 年龄, 相位角, 死亡风险

Abstract：Objective To evaluate the prognostic value of body composition and sarcopenia in patients with chronic obstructive pulmonary disease COPD . Method A total of 185 COPD patients admitted to Nantong Cancer Hospital from June 2021 to June 2022 were included. The patients were followed up for 1 year and their survival was recorded. All patients' clinical information baseline data were measured and recorded at admission. General information included age sex BMI hypertension and diabetes. Body composition indicators include waist circumference phase angle midarm circumference calf circumference. Result A total of 185 patients observed 16 died representing a mortality rate of 8. 6%. According to whether the patients died or not the results showed that The age and incidence of sarcopenia in death group were significantly higher than those in survival group while the phase angle was significantly lower in death group compared to the survival group with statistically significant differences P<0. 05 . Cox proportional model results showed that age reduction was significantly associated with a lower risk of death in COPD patients HR= 0. 832 95%CI = 0. 706-0. 982 P= 0. 030 . Sarcopenia was significantly associated with an increased risk of death in COPD patients HR = 3. 377 95% CI = 1. 126- 10. 1330 P = 0. 030 . Decreased phase Angle was significantly associated with increased risk of death in COPD patients HR= 2. 746 95% CI = 1. 165-6. 472 P= 0. 021 . ROC curve results showed that the AUC of age predicting the prognosis of COPD was 0. 814 the maximum Youden index was 0. 546 the corresponding sensitivity was 88. 2% and the specificity was 66. 4%. Sarcopenia predicted the outcome of COPD with an AUC of 0. 780 a maximum Youden index of 0. 417 a corresponding sensitivity of 64. 7% and a specificity of 77. 0%. The phase angle predicted the prognosis of COPD with an AUC of 0. 850 a maximum Youden index of 0. 612 a corresponding sensitivity of 88. 2% and a specificity of 73. 0%. Conclusion Both decreased phase angle and sarcopenia were significantly associated with an increased risk of death in COPD patients. Decreased phase angle and sarcopenia have high prognostic value in COPD patients. However due to the relatively small sample size in this study the model's stability is suboptimal.

Key words： Body composition Calf circumference Sarcopenia Chronic obstructive pulmonary disease Prognosis Age Phase angle Risk of death

通讯作者: 季红燕,电子邮箱:925331785@ qq. com

引用本文:

顾佳圩,朱向阳, 季红燕,徐琰. 身体成分和肌肉减少症对慢性阻塞性肺疾病患者预后的评估价值[J]. 肿瘤代谢与营养电子杂志, 2025, 12(2): 215-220.
Gu Jiawei, Zhu Xiangyang, Ji Hongyan, Xu Yan. Assessment of body composition and sarcopenia in the prognosis of patients with chronic obstructive pulmonary disease. Electron J Metab Nutr Cancer, 2025, 12(2): 215-220.