Effects Of Sarcopenia On Pulmonary Function And Blood Gas Analysis Of COPD,Asthma And ACO Patients

Objective:To investigate how sarcopenia influence the pulmonary function and arterial blood gas in chronic obstructive pulmonary disease（COPD）,asthma and asthma–COPD overlap syndrome（ACO）patients,and risk factors for developing sarcopenia.Methods:A total of 148 patients were enrolled in our study,who were admitted to the Department of Respiratory and critical care medicine,Bethune first hospital,Jilin University from January 2021 to December 2022.They were divided into COPD group（n=52）,asthma group（n=42）and ACO group（n=54）.Besides,51 healthy volunteers joined the study as a healthy control group.General information,body composition,pulmonary function,arterial blood gas and serological indicators of all patients were collected.Then,COPD,asthma and ACO patients were divided into two groups respectively according to whether the patients were combined with sarcopenia,to analyze the occurrence of sarcopenia in different obstructive respiratory diseases and risk factors for developing sarcopenia.Results:1.Compared with the healthy control group,patients in the COPD and ACO groups were older（P<0.05）and possessed lower BMI（P<0.05）.The proportion of patients who smoke in COPD and ACO group was higher than that in healthy control group（P<0.05）.The activities of daily living（ADL）scores of patients in the COPD and ACO group were lower than that in the healthy control group（P<0.05）.2.In terms of lung function:（1）FVC,FVC%pred,FEV₁/FVC,FEV₁%pred,PEF,PEF%pred,PIF,MVV%pred,lung reserve rate,and D_LCO%pred were significantly decreased in patients of COPD group compared with those in control group（P<0.01）.FEF_75%,FEF_50%,FEF_25%and FEF_25%-75%in COPD were significantly lower than that in healthy controls（P<0.01）.（2）Compared with the control group,the FEF25%of patients in the asthma group decreased significantly（P<0.05）.（3）Compared with the control group,FVC,FEV₁/FVC,FVC%pred,FEV₁%pred,FEV₁%pred,FEV₁/FVC,PEF,PEF%pred,PIF,MVV%pred and lung reserve rate in the ACO group were significantly decreased（P<0.01）.The FEF_75%,FEF_50%,FEF_25%and FEF_25%-75%of patients in the ACO group were significantly lower than those in the control group（P<0.01）.In addition,RV%pred,RV/TLC%pred,and FRC%pred of ACO group patients were higher than those in control individuals（P<0.05）,which was consistent with the characteristics of the disease.3.For body composition analysis,both FM and FFMI of COPD patients were reduced compared with healthy controls（P<0.05）.In addition,the SMM,left and right leg muscle mass,and SMI of COPD patients decreased significantly（P<0.05）.Finally,the phase angle（Ph A）and TBW of COPD patients were lower than those of control individuals（P<0.05）.There was no statistically significant difference in body composition between the patients in asthma group and the control group.The Ph A of patients in the ACO group was lower than that in the control group（P<0.05）.4.For basic data and serological tests of COPD,asthma,and ACO patients with sarcopenia,it was found that COPD patients with sarcopenia was significantly older than non-sarcopenia COPD patients（P<0.01）.Cholinesterase（CHE）in asthma with sarcopenia was lower compared to non-sarcopenia asthma patients（P<0.05）.Moreover,prealbumin,triglycerides,and hemoglobin in ACO patients with sarcopenia were significantly lower than those non-sarcopenia ACO patients（P<0.05）.5.Regarding lung function for sarcopenia,FEV₁/FVC,D_LCO%pred,and D_LCO/V_A%pred in COPD patients with sarcopenia were significantly lower than those in non-sarcopenia patients（P<0.05）.The D_LCO/V_A%pred of asthma patients with sarcopenia was lower than that of non-sarcopenia asthma patients（P<0.05）.The FEV₁/FVC of ACO patients with sarcopenia was lower than that of non-sarcopenia ACO patients（P<0.05）.6.For arterial blood gas of sarcopenia patients,the lactic acid（LAC）of COPD patients with sarcopenia was significantly lower than that of non-sarcopenia COPD patients without sarcopenia（P<0.01）.7.For body composition analysis of sarcopenia patients,the FM,FM%,FMI,FFM and FFMI in COPD patients with sarcopenia were significantly lower than those of non-sarcopenia COPD patients（P<0.01）.Meanwhile,COPD patients with sarcopenia had significantly decreased SMM,SMI,trunk and limb muscle content compared to non-sarcopenia COPD patients（P<0.01）.In addition,the Ph A and TBW of COPD patients with sarcopenia were lower than those without sarcopenia（P<0.05）.The FM,FMI,SMM,trunk,left arm,left leg,right leg muscle mass and SMI of asthma patients with sarcopenia were all significantly devalued compared to those of non-sarcopenia asthma patients（P<0.01）.Asthma patients with sarcopenia showed depressed Ph A,TBW,and ECW compared to non-sarcopenia asthma patients,with statistically significant differences（P<0.01）.ACO patients with sarcopenia demonstrated decreased FFM and FFMI compared to those without sarcopenia（P<0.01）.Meanwhile,ACO patients with sarcopenia showed lower SMM,trunk,left and right arm,left and right leg muscle mass and SMI compared to non-sarcopenia（P<0.01）.In addition,the Ph A,TBW,and ECW in ACO patients with sarcopenia were also significantly lower than those of non-sarcopenia ACO patients（P<0.01）.8.In COPD patients,SMM,SMI,the muscle mass of the left leg and right leg,FM and FMI,and Ph A were positively correlated with D_LCO%pred as pulmonary dispersion function（P<0.05）.FM,FFMI,and Ph A were positively correlated with FEV₁/FVC.In asthma patients,FM and FFMI were positively associated with D_LCO/V_A%pred（P<0.05）.In ACO patients,there was a positive correlation between FFM,FFMI,Ph A,total body fluid,ECW/TBW,and D_LCO/V_A%pred（P<0.05）.9.Logistic regression was used to analyze the risk factors of COPD patients with sarcopenia.FEV₁%pred,D_LCO/V_A%pred,PaCO₂,smoking,and age were included,among which D_LCO/V_A%pred and age were independent risk factors.Conclusions:1.Sarcopenia affected pulmonary function in COPD,asthma,and ACO patients.The FEV₁/FVC and D_LCO/V_A%pred of COPD patients with sarcopenia were both reduced.In asthma patients,combined sarcopenia only lower D_LCO/V_A%pred levels.In ACO patients,reduction of FEV₁/FVC was observed in sarcopenia patients.2.The presence or absence of sarcopenia was no significant effects on PaCO₂and PaO₂in patients with COPD,asthma,and ACO.3.Aging and decreased D_LCO/V_A%pred are risk factors for COPD developing sarcopenia.