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联合运动训练对慢性阻塞性肺疾病合并肌少症老年患者运动能力和炎症因子的影响
Effects of combined exercise training on exercise ability and inflammatory factors in elderly patients with chronic obstructive pulmonary disease complicated with sarcopenia
收稿日期:  
DOI:10.3969/j.issn.1673-9701.2024.19.003
关键词:  慢性阻塞性肺疾病  肌少症  有氧运动  抗阻运动  炎症因子
Key Words:
基金项目:浙江省医药卫生科技计划项目(2019KY502);杭州市科技计划引导项目(20211231Y033)
作者单位
任谦 杭州市第三人民医院老年医学科浙江杭州 310009 
王琴 杭州市第三人民医院老年医学科浙江杭州 310009 
林萍 杭州市第三人民医院老年医学科浙江杭州 310009 
孔程程 杭州市第三人民医院老年医学科浙江杭州 310009 
陈娜 杭州市第三人民医院康复科浙江杭州 310009 
张彬 杭州市第三人民医院老年医学科浙江杭州 310009 
金益萍 杭州市第三人民医院老年医学科浙江杭州 310009 
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摘要:目的 探讨联合运动训练对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肌少症老年患者的运动能力和炎症因子的影响。方法 选取2022年7月至2023年5月就诊于杭州市第三人民医院的COPD合并肌少症老年患者60例为研究对象,根据随机数字表法将其分为对照组和治疗组,每组各30例。对照组患者接受COPD常规治疗,治疗组患者在此基础上进行12周的联合运动训练。比较两组患者治疗前后四肢骨骼肌质量指数(appendicular skeletal muscle mass index,ASMI)、握力、步速、6分钟步行距离(6 min walking distance,6MWD)、慢性阻塞性肺疾病评估测试(COPD assessment test,CAT)、第一秒用力呼气容积(forced expiratory volume in one second,FEV1)/用力肺活量(forced vital capacity,FVC)、血清白细胞介素-6(interleukin-6,IL-6)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),分析血清IL-6和TNF-α与ASMI、握力、步速的相关性。结果 治疗后,两组患者的6MWD均显著长于本组治疗前,CAT评分均显著低于本组治疗前(P<0.05),治疗组患者的ASMI、握力、步速均显著大于本组治疗前,血清IL-6、TNF-α均显著低于本组治疗前(P<0.05);治疗组患者的ASMI、握力、步速均显著大于对照组,6MWD显著长于对照组,CAT评分、血清IL-6和TNF-α均显著低于对照组(P<0.05);两组患者治疗前后FEV1/FVC比较差异均无统计学意义(P>0.05)。Pearson相关分析显示,血清IL-6、TNF-α与ASMI、握力、步速均呈负相关(P<0.05)。结论 联合运动训练可提高COPD合并肌少症老年患者的肌肉质量和力量,改善运动能力和临床症状,抑制炎症反应。
Abstract:Objective To investigate the effects of combined exercise training on exercise ability and inflammatory factors in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with sarcopenia. Methods Sixty elderly patients with COPD complicated with sarcopenia who were treated in Hangzhou Third People’s Hospital from July 2022 to May 2023 were selected as study objects, and were divided into control group and treatment group according to random number table method, with 30 cases in each group. The control group received routine treatment of COPD, while the treatment group received combined exercise training on the basis of routine treatment for 12 weeks. The appendicular skeletal muscle mass index (ASMI), grip strength, walking speed, 6 min walking distance (6MWD), COPD assessment test (CAT), forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC)、serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were compared. The correlation between serum IL-6、TNF-α and ASMI, grip strength、walking speed were analyzed. Results After treatment, 6MWD in both groups was significantly longer than before treatment, and CAT score was significantly lower than before treatment (P<0.05). The ASMI, grip strength and walking speed of patients in treatment group were significantly higher than before treatment, and the serum IL-6 and TNF-α were significantly lower than before treatment (P<0.05). The ASMI, grip strength and walking speed of treatment group were significantly higher than those of control group, 6MWD was significantly longer than that of control group, CAT score, serum IL-6 and TNF-α were significantly lower than those of control group (P<0.05). There was no significant difference in FEV1/FVC between two groups before and after treatment (P>0.05). Pearson correlation analysis showed that serum IL-6、TNF-α were negatively correlated with ASMI、grip strength and walking speed. Conclusion Combined exercise training can improve muscle mass and strength, improve exercise ability and clinical symptoms, and inhibit inflammatory response in elderly patients with COPD complicated with sarcopenia.
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