摘要
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 correlation between body mass index （BMI） and chronic obstructive pulmonary disease （COPD） , based on a cross-sectional COPD survey conducted in Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Cbengqing and Shaanxi of China between 2002-2004. Methods A multi-stage stratification cluster sampling strategy was used in this cross-sectional survey, and 2 0245 subjects （8705 males and 11 540 females） aged 40 years or older were recruited, interviewed with a questionnaire, measured for height and weight, and tested with spirometry. 1668 subjects with postbronchodilator FEV1/FVC less than 70% were identified as having COPD after other known causes of airflow limitation were excluded. Analysis on relationship between COPD and BMI was performed in 1668 COPD and 18 577 non-COPD subjects. Resulls Compared with non-COPD subjects, BMI was significantly lower in COPDpatients [（22.7 ±3.5） vs （24. 1±3.4） kg/m^2, F= 158. 31, P 〈0.01]; BMI was also significantly lower in smokers than in non-smokers [ （ 23.6 ± 3.4 ） vs （ 24.2 ± 3.5 ） kg/m^2, F = 49. 10, P 〈0. 01 ]. And an addictive interaction to BMI between COPD and smoking was observed （F =6. 03, P 〈 0. 05 ）. BMI decreased with the increase of the stage of COPD （ F = 45.6, P 〈 0. 01 ） , with a negative relationship （r = -0. 08 ,P 〈 0. 01 ）. Lower BMI was significantly associated with increased risk of COPD （X^2 = 102.68,P〈0.01）. Compared with subjects with normal BMI（BMI = 24.0 -27.9 kg/m^2） , those with lower BMI （ BMI 〈 18.5 kg/m^2 ） were more likely to have COPD [ adjusted OR = 2. 12 （95% Cl 1.73 - 2.59） ], while those with higher BMI （ BMI = 24. 0 - 27.9 kg/m^2 ） and obesity （ BMI ≥ 28. 0 kg/m^2 ） were less likely to have COPD [adjusted OR =0. 67 （95% Cl 0. 59 -0.76） ;and 0.60 [ （95% Cl 0. 49-0. 73）, respectively]. Moreover, there was an interaction to COPD between smoking and BMI （X^2 = 4. 73 ,P 〈 0. 05 ）. Compared with COPD patients with normal BMI, the quality of life in those with lower BMI was impaired （ 55 ± 8 vs 57 ± 6 in mental scores of SF-12, F = 2. 96, P 〈 0. 05 ; 42 ± 10 vs 46 ± 9 in physical scores of SF-12, F = 4. 21 ,P 〈 0. 01 ）, and their dyspnea scores were higher（ 1.4± 1.5 vs 1.1 ±1.3, X^2 = 14. 32, P 〈 0. 01 ）. Conclusion Lower BMI was strongly associated with COPD, possibly as a risk factor for COPD independent of smoking, and a potential predictor for COPD severity.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2007年第1期18-22,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家"十五"攻关课题资助项目[2001BA703B03(A)]
广东省"十五"重点支持项目(B30301)
关键词
肺疾病
慢性阻塞性
体重指数
生活质量
Pulmonary disease, chronic obstructive
Body mass index
Quality of life
