肺気腫患者のエネルギー代謝と体成分・呼吸筋力・血清サイトカインとの関連性に関する研究

Abstract

Increased resting energy expenditure (REE) in underweight patients with pulmonary emphysema has been previously reported. However, the determinants of REE have not been clearly demonstrated. The purpose of this study was to investigate the relations of pulmonary function, respiratory muscle strength (PⅠmax, PEmax), body compo- sition (FM/IBW, FFM/IBW), and serum cytokines (tumor necrosis factor α (TNF-α), soluble tumor necrosis receptor type Ⅰ, Ⅱ (sTNF-R Ⅰ, Ⅱ)) to REE in 37 male clinically stable outpatients with pulmonary emphysema (age : 69.0±6.5, % IBW : 84.7±15.2, FEV1.0 : 1.26±0.57). Also, I compared them with those in 17 age-and sex-matched healthy controls (age : 70.0±6.9,% IBW : 98.9±16.3), malnourished patients (% IBW＜90 ; 75.2± 8.8, N=22, group A), and normonourished patients (% IBW≧90 ; 99.4±8.8, N=15, group B). REE was expressed as percentage predicted (% REE), REE/FFM and VO2/FFM. FFM/IBW, FM/IBW, P1max, PEmax were significantly lower and % REE, REE/FFM, VO2 /FFM, all cytokines were significantly higher in group A than group B and controls. By stepwise regression analysis, variables significantly contributing to % REE were FFM/ IBW, TLC, and FEV1.0 in group A. These data may suggest that increase in REE in underweight patients with pulmonary emphysema is associated with a decrease in FFM which is accompanied by decrease in respiratory muscle strength, airway obstruction, and hyperinflation.