论文部分内容阅读
目的在2002至2004年中国7个地区(北京、上海、广东、辽宁、天津、重庆和陕西)慢性阻塞性肺疾病(COPD)现况调查的基础上,探讨体重指数(BMI)与 COPD 的关系。方法现况调查采用多阶段分层整群随机抽样方法,对40岁及以上的居民进行问卷调查、身高和体重的测量及肺功能检测。调查有效人数为20245名,男8705名,女11540名,以支气管扩张试验后第一秒用力呼气容积/用力肺活量(FEV_1/FVC)<70%作为 COPD 的诊断标准,并排除其他已知的气流受限的疾病,共筛查出1668例 COPD 和18577例非 COPD 进行 BMI 与 COPD 的关系分析。结果 COPD 患者的BMI[(22.7±3.5)kg/m~2]较非 COPD 患者[(24.1±3.4)kg/m~2]低,吸烟者 BMI 为[(23.6±3.4)kg/m~2]较不吸烟者[(24.2±3.5)kg/m~2]低,差异均有统计学意义(F 分别为158.31、49.10,P 均<0.01),且 COPD 与吸烟存在对 BMI 的交互作用(F=6.03,P<0.05)。COPD 病情程度分级越高 BMI越低(F=45.46,P<0.01),COPD 病情程度分级与 BMI 分级存在负相关(r=-0.08,P<0.01)。BMI 越低 COPD 的患病率越高(趋势 X~2=102.68,P<0.01),多因素 logistic 回归分析显示,与正常BMI(18.5～23.9 kg/m~2)比较,1级 BMI(<18.5 kg/m~2)、3级 BMI(24.0～27.9 kg/m~2)和4级 BMI(≥28.0 kg/m~2)患 COPD 的 OR 值分别为[2.12(1.73～2.59)、0.67(0.59～0.76)、0.60(0.49～0.73),P 均<0.05];且 BMI 分级与吸烟存在对 COPD 的交互作用(X~2=4.73,P<0.05)。与2级 BMI的 COPD 患者比较,1级 BMI 的 COPD 患者生活质量差(心理指数评分:55±8、57±6,F=2.96,P<0.05;躯体指数评分:42±10、46±9,F=4.21,P<0.01);气促分数高(1.4±1.5、1.1±1.3,X~2=14.32,P<0.01)。结论 1级 BMI 与 COPD 关系密切,其可能是 COPD 患病的独立于吸烟的危险因素,而低 BMI 也可能是 COPD 病情严重程度的一个重要指标。
Objective To investigate the relationship between body mass index (BMI) and COPD based on the investigation of the status of chronic obstructive pulmonary disease (COPD) in seven regions of China from 2002 to 2004 (Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Chongqing and Shaanxi) . Methodological status survey A multi-stage stratified cluster random sampling method was used to survey the residents aged 40 years and over, height and weight measurement and pulmonary function tests. The effective number of investigators was 20,245, including 8,705 men and 11,540 women. The first second forced expiratory volume / forced vital capacity (FEV_1 / FVC) <70% after bronchodilator was used as the diagnostic criteria for COPD and other known Airflow limited disease were screened out a total of 1668 cases of COPD and 18577 cases of non-COPD BMI and COPD relationship analysis. Results The BMI in patients with COPD was significantly lower than that in patients without COPD [(22.7 ± 3.5) kg / m 2 vs [(24.1 ± 3.4) kg / m 2 vs [23.6 ± 3.4] kg / m 2 ] Were significantly lower than those in non-smokers [(24.2 ± 3.5) kg / m 2] (F = 158.31 and 49.10 respectively, P <0.01), and there was an interaction between COPD and smoking on BMI F = 6.03, P <0.05). The higher the grade of COPD, the lower the BMI (F = 45.46, P <0.01). There was a negative correlation between COPD severity and BMI (r = -0.08, P <0.01). The lower the BMI, the higher the prevalence of COPD (trend X ~ 2 = 102.68, P <0.01). The multivariate logistic regression analysis showed that the level of BMI in grade 1 was significantly lower than that in normal BMI (18.5-23.9 kg / OR of 18.5 kg / m 2, COPD of grade 3 BMI 24.0-27.9 kg / m 2 and grade 4 BMI 28.0 kg / m 2 were 2.12 (1.73-2.59) and 0.67 (0.59 ~ 0.76), 0.60 (0.49 ~ 0.73), P <0.05 respectively. There was also an interaction between BMI and smoking on COPD (X ~ 2 = 4.73, P <0.05). COPD patients with grade 1 BMI had worse quality of life (Mental Index Score 55 ± 8,57 ± 6, F = 2.96, P <0.05; Body Index Score 42 ± 10,46 ± 9 , F = 4.21, P <0.01). The score of shortness of breath was high (1.4 ± 1.5,1.1 ± 1.3, X ~ 2 = 14.32, P <0.01). Conclusions Grade 1 BMI is closely related to COPD, which may be a risk factor for smoking-independent COPD. Low BMI may also be an important indicator of the severity of COPD.