目的探讨慢性阻塞性肺疾病(慢阻肺)稳定期患者营养状况和氧化应激能力与肺功能的关系。
方法收集2014年6至8月泸州医学院附属医院(现更名为西南医科大学附属医院)、泸州市江南医院和泸州市龙马潭区红十字医院体检的慢阻肺稳定期患者200例(慢阻肺组)和100名健康体检者(对照组)。其中慢阻肺组男119例，女81例；年龄42～87岁，平均年龄(68±8)岁；对照组男49名，女51名；年龄51～87岁，平均年龄(68±8)岁。检测血清蛋白质羰基(PC)、丙二醛、8－羟基脱氧鸟苷(8－OHdG)、总抗氧化能力(TAC)的水平，同时对受试者进行肺功能测量，并采用微型营养评定(MNA)对受试者进行营养状况评估，慢阻肺组按MNA评分进一步分为营养良好亚组和营养不良(风险)亚组。不符合正态分布的定量资料采用中位数(四分位数间距)表示。
结果慢阻肺组血清PC、丙二醛、8－OHdG的浓度分别为3.82(1.79, 6.83)μg/L和3.89(2.77, 5.40)μmol/L、359.18(259.25, 587.85) μg/L，明显高于对照组2.29(1.08, 3.26) μg/L、3.08(2.32, 4.03)μmol/L、311.37(265.47, 374.08) ng/L；而慢阻肺组血清TAC的水平为11.35(4.81, 20.20)U/ml，显著低于对照组[18.81(15.21, 23.19)U/ml，均 P<0.01]。上臂肌围、小腿周径、体重指数和MNA中人体测量、总体评价、膳食评估、主观评定及MNA总分，营养良好亚组均低于营养不良风险亚组(均 P<0.05)。营养不良(风险)亚组血清PC和TAC的水平分别为6.10(3.02, 8.18)μg/L和13.33(6.07, 23.96)U/ml，明显高于营养良好亚组[3.25(1.61, 5.37)μg/L、9.99(4.41, 16.77)U/ml]。营养不良(风险)亚组FEV 1占预计值%为42.90(34.68, 71.23)，FEV 1/FVC为46.96(38.96, 60.63)，均明显低于营养良好亚组[69.10(45.95, 89.23)，53.32(42.13, 63.15)，均 P<0.05]；上臂肌围、小腿周径、体重指数与MNA均呈正相关性( r值分别为0.498、0.587、0.781，均 P<0.001)，与PC呈负相关性( r值分别为－0.209、－0.195、－0.231，均 P<0.05)，与FEV 1占预计值%呈正相关性( r值分别为0.223、0.274、0.350，均 P<0.05)；上臂肌围、体重指数与FEV 1/FVC呈正相关性( r值分别为0.166、0.224，均 P<0.05)。慢阻肺患者血清PC的水平和FEV 1占预计值%是MNA的影响因素，且FEV 1占预计值%( β＝0.367， P<0.001)对MNA得分的影响较血清PC( β＝－0.304， P<0.001)的水平影响更大。
结论机体蛋白质羰基化、气流受限可能与慢阻肺患者发生营养不良密切相关。
ObjectiveTo investigate the association between the nutritional status of patients with chronic obstructive pulmonary disease (COPD) and the levels of serum oxidative stress markers protein carbonyls (PC), malondialdehyde (MDA), 8-hydroxy-2′-deoxyguanosine (8-OHdG), total antioxidant capacity (TAC) and pulmonary function.
Methods200 patients with stable COPD (the COPD group) and 100 healthy individuals (the control group) who visited during June 2014 and August 2014 were enrolled in our study. The levels of PC, MDA, 8-OHdG and TAC in serum were detected. Pulmonary function was tested. Nutritional status was assessed by mini nutritional assessment (MNA) that classified the nutrition class.
ResultsThe levels of PC, MDA, and 8-OHdG in serum increased significantly in the COPD group [3.82 (1.79, 6.83) μg/L, 3.89(2.77, 5.40) μmol/L and 359.18(259.25, 587.85) ng/L, respectively], and the levels of TAC in serum decreased significantly in COPD group [11.35(4.81, 20.20)U/ml], as compared with the control group [2.29(1.08, 3.26) μg/L, 3.08(2.32, 4.03) μmol/L, 311.37(265.47, 374.08) ng/L and 18.81(15.21, 23.19) U/ml, respectively, all P<0.05]. All the nutrition assessment parameters were gradually decreased as nutritional status worsen (all P<0.05). In malnourished (risk) COPD subgroup, the levels of PC and TAC in serum increased significantly [6.10(3.02, 8.18) μg/L and 13.33(6.07, 23.96) U/ml, respectively] and the FEV 1% and FEV 1/FVC index decreased significantly [42.90(34.68, 71.23) and 46.96(38.96, 60.63), respectively] as compared the well-nourished COPD subgroup [3.25(1.61, 5.37) μg/L, 9.99(4.41, 16.77) U/ml, 69.10(45.95, 89.23) and 53.32(42.13, 63.15), all P<0.05]. Furthermore, we had found that the upper arm muscle circumference, calf circumference and BMI were positively correlated with MNA ( r=0.498, 0.587, 0.781, P<0.001), negatively correlated with PC ( r=-0.209, -0.195, -0.231, P<0.05) and positively correlated with FEV 1% ( r=0.223, 0.274, 0.350, P<0.05). The upper arm muscle circumference and BMI were positively correlated with FEV 1/FVC ( r=0.166, 0.224, P<0.05). In COPD group, the level of PC in serum and FEV 1% were important factor in MNA score, and the impacts of FEV 1% were greater than the level of PC( β=0.367, -0.304, P<0.001).
ConclusionThe protein carbonylation and airflow limitation might be closely related to malnutrition.
蒋雪莲,钟萍,黄成亮,等. 稳定期慢性阻塞性肺疾病患者营养状况和氧化应激能力与肺功能的关系[J]. 中华结核和呼吸杂志,2017,40(1)：40-45.
DOI:10.3760/cma.j.issn.1001-0939.2017.01.009版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
