成人超重和肥胖患者体重指数与肺功能的关系_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

宋心月 , 徐文静 , 段昊玙 ,  梁斌苗

四川大学华西医院呼吸与危重症医学科（四川成都 610041）;

Corresponding author：

梁斌苗, Email: liangbinmiao@163.com

Keywords：

肥胖; 肺功能; 一氧化碳弥散量

DOI：

10.7507/1671-6205.202404019

Video：

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目的探讨成人超重和肥胖患者人体重指数（BMI）与肺功能的关系，并试图分析极度肥胖（BMI>40 kg/m²）患者弥散功能的改变。方法回顾性收集2021年1月—2023年12月到四川大学华西医院就诊的超重和肥胖患者390例的一般资料和肺功能数据，根据患者身高和体重计算BMI。根据世界卫生组织肥胖分级，分为超重组（25 kg/m²≤BMI<30 kg/m²，n=37）、Ⅰ级肥胖组（30 kg/m²≤BMI<35 kg/m²，n=106）、Ⅱ级肥胖组（35 kg/m²≤BMI<40 kg/m²，n=110）和Ⅲ级肥胖组（BMI≥40 kg/m²，n=137）。采用方差分析或Wilcoxon配对符号秩检验比较根据BMI不同分组间患者的肺功能指标。Spearman或Pearson相关性分析判定BMI与肺功能各指标之间的相关性，并使用简单线性回归或分段线性回归进行相关性分析。结果不同BMI分组在超重和肥胖患者中年龄、性别和吸烟史的差异有统计学意义（P<0.05）。肺功能数据比较：Ⅲ级肥胖组用力肺活量占预计值百分比（FVC%pred）、肺总量占预计值百分比（TLC%pred）、肺活量占预计值百分比（VC%pred）、第1秒用力呼气容积占预计值百分比（FEV₁%pred）、最大呼气流量占预计值百分比（PEF%pred）低于超重组和Ⅰ级肥胖组（P<0.05），超重组深吸气量占预计值百分比（IC%pred）高于Ⅰ级肥胖组、Ⅱ级肥胖组和Ⅲ级肥胖组（P<0.05），超重组和Ⅰ级肥胖组肺一氧化碳弥散量占预计值百分比（D_LCO%pred）低于Ⅱ级肥胖组（P<0.05），FEV₁/FVC、峰值呼气中段流量占预计值百分比（MMEF%pred）在四组之间没有明显差异。相关性分析显示，VC%pred（r=–0.254，P<0.05）、TLC%pred（r=–0.151，P<0.05）与BMI呈负相关。BMI<40 kg/m²时，D_LCO%pred与BMI正相关（r₁=0.224，P<0.05）；BMI≥40 kg/m²时，D_LCO%pred与BMI呈负相关（r₂=–0.176，P<0.05）。结论随着BMI升高，超重和肥胖患者肺通气功能下降，主要表现为限制性通气功能障碍。当BMI<40 kg/m²时，超重和肥胖患者弥散功能随BMI增加而升高，可能原因是其肺血容量增加使D_LCO%pred升高；但BMI≥40 kg/m²时，患者弥散功能随BMI增加而下降，可能原因是极度肥胖时肺泡组织受脂肪浸润或结缔组织沉积导致的扩散障碍。

Citation： 宋心月, 徐文静, 段昊玙, 梁斌苗. 成人超重和肥胖患者体重指数与肺功能的关系. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(11): 802-806. doi: 10.7507/1671-6205.202404019 Copy

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1. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care, 2016, 22(7 Suppl): s176-s185.
2. 《中国居民营养与慢性病状况报告(2020年)》: 我国超过一半成年居民超重或肥胖. 中华医学信息导报, 2020, 35(24): 15.
3. Peters U, Dixon AE, Forno et al. Obesity and asthma. J Allergy Clin Immun, 2018, 141(4): 1169-1179.
4. Behazin N, Jones SB, Cohen RI, et al. Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. J Appl Physiol, 2009, 108: 212-218.
5. Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol, 1960, 15: 377-382.
6. Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg, 1998, 87: 654-660.
7. Mancuso P. Obesity and lung inflammation. J Appl Physiol, 2010, 108(3): 722-728.
8. McLaughlin T, Craig C, Liu LF, et al. Adipose cell size and regional fat deposition as predictors of metabolic response to overfeeding in insulin resistant and insulin-sensitive humans. Diabetes, 2016, 65(5): 1245-1254.
9. Porro S, Genchi VA, Cignarelli A, et al. Dysmetabolic adipose tissue in obesity: morphological and functional characteristics of adipose stem cells and mature adipocytes in healthy and unhealthy obese subjects. J Endocrinol Invest, 2021, 44(5): 921-941.
10. Saydain G, Beck KC, Decker PA, et al. Clinical significance of elevated diffusing capacity. Chest, 2004, 125(2): 446-452.
11. Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest, 2006, 130(3): 827-833.
12. Ray CS, Sue DY, Bray G, et al. Effects of obesity on respiratory function. Am Rev Respir Dis, 1983, 128(3): 501-506.
13. 中华医学会呼吸病学分会肺功能专业组. 肺功能检查指南–肺弥散功能检查. 中华结核和呼吸杂志, 2015, 38(3): 164-169.
14. Enache I, Oswald M, Scarfone S, et al. Impact of altered alveolar volume on the diffusing capacity of the lung for carbon monoxide in obesity. Respiration, 2011, 81(3): 217-222.
15. Chance WW, Rhee C, Yilmaz C, et al. Diminished alveolar microvascular reserves in type 2 diabetes reflect systemic microangiopathy. Diabetes Care, 2008, 31(8): 1596-1601.
16. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J, 2022, 60(1): 2101499.
17. Jian WH, Gao Y, Hao CL, et al. Reference values for spirometry in Chinese aged 4-80 years. J Thorac Dis, 2017, 9(11): 4538-4549.
18. 徐春燕, 郭水根, 沈瑶. 中心性肥胖对肺功能的影响. 临床肺科杂志, 2018, 23(2): 281-283.
19. 王金祥, 胥振扬, 张淑明, 等. 轻中度肥胖症对非吸烟成人肺功能影响的研究. 中国呼吸与危重监护杂志, 2005, 4(3): 218-220.
20. Hsu YE, Chen SC, Geng JH, et al. Obesity-related indices are associated with longitudinal changes in lung function: a large Taiwanese population follow-up study. Nutrients, 2021, 13(11): 4055.
21. Thomas PS, Cowen ER, Hulands G, et al. Respiratory function in the morbidly obese before and after weight loss. Thorax, 1989, 44(5): 382-386.
22. Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med, 2018, 12(9): 755-767.
23. Boriek AM, Lopez MA, Velasco C, et al. Obesity modulates diaphragm curvature in subjects with and without COPD. Am J Physiol Regul Integr Comp Physiol, 2017, 313(5): R620-R629.
24. Pelosi P, Luecke T, Rocco PR. Chest wall mechanics and abdominal pressure during general anaesthesia in normal and obese individuals and in acute lung injury. Curr Opin Crit Care, 2011, 17: 72-79.
25. Zavorsky GS, Hoffman SL. Pulmonary gas exchange in the morbidly obese. Obesity Reviews, 2008, 9(4): 326-339.

Chinese Journal of Respiratory and Critical Care Medicine

成人超重和肥胖患者体重指数与肺功能的关系

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