成人超重和肥胖患者體重指數與肺功能的關系_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

宋心月 , 徐文靜 , 段昊玙 ,  梁斌苗

四川大學華西醫院呼吸與危重癥醫學科（四川成都 610041）;

Corresponding?author：

梁斌苗, Email: liangbinmiao@163.com

Keywords：

肥胖; 肺功能; 一氧化碳彌散量

DOI：

10.7507/1671-6205.202404019

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目的探討成人超重和肥胖患者人體重指數（BMI）與肺功能的關系，并試圖分析極度肥胖（BMI>40 kg/m²）患者彌散功能的改變。方法回顧性收集2021年1月—2023年12月到四川大學華西醫院就診的超重和肥胖患者390例的一般資料和肺功能數據，根據患者身高和體重計算BMI。根據世界衛生組織肥胖分級，分為超重組（25 kg/m²≤BMI<30 kg/m²，n=37）、Ⅰ級肥胖組（30 kg/m²≤BMI<35 kg/m²，n=106）、Ⅱ級肥胖組（35 kg/m²≤BMI<40 kg/m²，n=110）和Ⅲ級肥胖組（BMI≥40 kg/m²，n=137）。采用方差分析或Wilcoxon配對符號秩檢驗比較根據BMI不同分組間患者的肺功能指標。Spearman或Pearson相關性分析判定BMI與肺功能各指標之間的相關性，并使用簡單線性回歸或分段線性回歸進行相關性分析。結果不同BMI分組在超重和肥胖患者中年齡、性別和吸煙史的差異有統計學意義（P<0.05）。肺功能數據比較：Ⅲ級肥胖組用力肺活量占預計值百分比（FVC%pred）、肺總量占預計值百分比（TLC%pred）、肺活量占預計值百分比（VC%pred）、第1秒用力呼氣容積占預計值百分比（FEV₁%pred）、最大呼氣流量占預計值百分比（PEF%pred）低于超重組和Ⅰ級肥胖組（P<0.05），超重組深吸氣量占預計值百分比（IC%pred）高于Ⅰ級肥胖組、Ⅱ級肥胖組和Ⅲ級肥胖組（P<0.05），超重組和Ⅰ級肥胖組肺一氧化碳彌散量占預計值百分比（D_LCO%pred）低于Ⅱ級肥胖組（P<0.05），FEV₁/FVC、峰值呼氣中段流量占預計值百分比（MMEF%pred）在四組之間沒有明顯差異。相關性分析顯示，VC%pred（r=–0.254，P<0.05）、TLC%pred（r=–0.151，P<0.05）與BMI呈負相關。BMI<40 kg/m²時，D_LCO%pred與BMI正相關（r₁=0.224，P<0.05）；BMI≥40 kg/m²時，D_LCO%pred與BMI呈負相關（r₂=–0.176，P<0.05）。結論隨著BMI升高，超重和肥胖患者肺通氣功能下降，主要表現為限制性通氣功能障礙。當BMI<40 kg/m²時，超重和肥胖患者彌散功能隨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時，患者彌散功能隨BMI增加而下降，可能原因是極度肥胖時肺泡組織受脂肪浸潤或結締組織沉積導致的擴散障礙。

Citation： 宋心月, 徐文靜, 段昊玙, 梁斌苗. 成人超重和肥胖患者體重指數與肺功能的關系. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(11): 802-806. doi: 10.7507/1671-6205.202404019 Copy

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18.	徐春燕, 郭水根, 沈瑤. 中心性肥胖對肺功能的影響. 臨床肺科雜志, 2018, 23(2): 281-283.
19.	王金祥, 胥振揚, 張淑明, 等. 輕中度肥胖癥對非吸煙成人肺功能影響的研究. 中國呼吸與危重監護雜志, 2005, 4(3): 218-220.
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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.
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25.	Zavorsky GS, Hoffman SL. Pulmonary gas exchange in the morbidly obese. Obesity Reviews, 2008, 9(4): 326-339.

1. Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care, 2016, 22(7 Suppl): s176-s185.
2. 《中國居民營養與慢性病狀況報告(2020年)》: 我國超過一半成年居民超重或肥胖. 中華醫學信息導報, 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. 中華醫學會呼吸病學分會肺功能專業組. 肺功能檢查指南–肺彌散功能檢查. 中華結核和呼吸雜志, 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, 沈瑤. 中心性肥胖對肺功能的影響. 臨床肺科雜志, 2018, 23(2): 281-283.
19. 王金祥, 胥振揚, 張淑明, 等. 輕中度肥胖癥對非吸煙成人肺功能影響的研究. 中國呼吸與危重監護雜志, 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體重指數與肺功能的關系

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