关于并发症对重度肥胖女性静息及活动相关呼吸困难影响的横断面研究
2017/10/09
摘要
目的：肥胖与哮喘控制不佳相关，但这也可能受到其他肥胖相关并发症的影响。本横断面研究旨在根据肥胖相关并发症的存在与否（无症状性气道高反应（AHR）、哮喘、胃食管反流病（GERD组）及睡眠呼吸紊乱）来描述静息及活动相关呼吸困难。本文推断肥胖女性可出现独立于哮喘的静息及活动相关呼吸困难。
方法：严重肥胖女性（体重指数>35 kg/m2）分别完成关于静息及活动相关呼吸暂停描述（言语描述和医学研究委员会（MRC）量表）的描述，肺功能测试（肺活量测定，绝对肺容积和乙酰甲胆碱激发试验），食道胃十二指肠纤维镜检查和整夜多导睡眠监测。研究纳入30例无气道高反应的清瘦女性。
结果：在肥胖女性中，静息时呼吸困难的发生率（41%）较健康女性（3%）高，其中胸闷及深呼吸需求与哮喘及GERD独立相关，而喘息、咳嗽与哮喘的相关性仅出现于肥胖女性。活动相关呼吸困难非常多见(MRC 评分>1, 75%)，且其与肥胖相关，但与哮喘所致的喘息加重无关。而无症状性AHR与SDB不会影响呼吸困难症状。
结论：对于需减重手术治疗的重度肥胖女性，静息性呼吸困难的主诉与哮喘或GERD相关，而活动性呼吸困难大多仅与肥胖相关。总的来说，肥胖女性出现的呼吸困难不能单用哮喘来解释。
Cross-sectional assessment of the roles of comorbidities in resting and activity-related dyspnea in severely obese women.
Essalhi M, Gillaizeau F, Chevallier JM, Ducloux R, Chevalier-Bidaud B
Abstract
OBJECTIVES:Obesity has been associated with a lesser degree of asthma control that may be biased by other comorbidities. The objectives of this cross-sectional study were to describe resting and activity-related dyspnea complaints according to the presence of obesity-related comorbidities (asymptomatic airway hyperresponsiveness (AHR), asthma, gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDB)). We hypothesized that obese women can exhibit both resting and activity-related dyspnea, independently of the presence of asthma.
METHODS:Severely obese (body mass index (BMI) > 35 kg m(-2)) women prospectively underwent description of resting and activity-related dyspnea (verbal descriptors and Medical Research Council (MRC) scale), pulmonary function testing (spirometry, absolute lung volumes, and methacholine challenge test), oesogastro-duodenal fibroscopy, and overnight polygraphy. Thirty healthy lean women without airway hyperresponsiveness were enrolled.
RESULTS:Resting dyspnea complaints were significantly more prevalent in obesity (prevalence 41%) than in healthy lean women (prevalence 3%). Chest tightness and the need for deep inspirations were independently associated with both asthma and GERD while wheezing and cough were related to asthma only in obese women. Activity-related dyspnea was very prevalent (MRC score > 1, 75%), associated with obesity, with the exception of wheezing on exertion due to asthma. Asymptomatic AHR and SDB did not affect dyspneic complaints.
CONCLUSIONS:In severely obese women referred for bariatric surgery, resting dyspnea complaints are observed in association with asthma or GERD, while activity-related dyspnea was mainly related to obesity only. Consequently, asthma does not explain all respiratory complaints of obese women.
目的：肥胖与哮喘控制不佳相关，但这也可能受到其他肥胖相关并发症的影响。本横断面研究旨在根据肥胖相关并发症的存在与否（无症状性气道高反应（AHR）、哮喘、胃食管反流病（GERD组）及睡眠呼吸紊乱）来描述静息及活动相关呼吸困难。本文推断肥胖女性可出现独立于哮喘的静息及活动相关呼吸困难。
方法：严重肥胖女性（体重指数>35 kg/m2）分别完成关于静息及活动相关呼吸暂停描述（言语描述和医学研究委员会（MRC）量表）的描述，肺功能测试（肺活量测定，绝对肺容积和乙酰甲胆碱激发试验），食道胃十二指肠纤维镜检查和整夜多导睡眠监测。研究纳入30例无气道高反应的清瘦女性。
结果：在肥胖女性中，静息时呼吸困难的发生率（41%）较健康女性（3%）高，其中胸闷及深呼吸需求与哮喘及GERD独立相关，而喘息、咳嗽与哮喘的相关性仅出现于肥胖女性。活动相关呼吸困难非常多见(MRC 评分>1, 75%)，且其与肥胖相关，但与哮喘所致的喘息加重无关。而无症状性AHR与SDB不会影响呼吸困难症状。
结论：对于需减重手术治疗的重度肥胖女性，静息性呼吸困难的主诉与哮喘或GERD相关，而活动性呼吸困难大多仅与肥胖相关。总的来说，肥胖女性出现的呼吸困难不能单用哮喘来解释。
（中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校）
（J Asthma. 2013;50(6):565-72.）
（J Asthma. 2013;50(6):565-72.）
Cross-sectional assessment of the roles of comorbidities in resting and activity-related dyspnea in severely obese women.
Essalhi M, Gillaizeau F, Chevallier JM, Ducloux R, Chevalier-Bidaud B
Abstract
OBJECTIVES:Obesity has been associated with a lesser degree of asthma control that may be biased by other comorbidities. The objectives of this cross-sectional study were to describe resting and activity-related dyspnea complaints according to the presence of obesity-related comorbidities (asymptomatic airway hyperresponsiveness (AHR), asthma, gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDB)). We hypothesized that obese women can exhibit both resting and activity-related dyspnea, independently of the presence of asthma.
METHODS:Severely obese (body mass index (BMI) > 35 kg m(-2)) women prospectively underwent description of resting and activity-related dyspnea (verbal descriptors and Medical Research Council (MRC) scale), pulmonary function testing (spirometry, absolute lung volumes, and methacholine challenge test), oesogastro-duodenal fibroscopy, and overnight polygraphy. Thirty healthy lean women without airway hyperresponsiveness were enrolled.
RESULTS:Resting dyspnea complaints were significantly more prevalent in obesity (prevalence 41%) than in healthy lean women (prevalence 3%). Chest tightness and the need for deep inspirations were independently associated with both asthma and GERD while wheezing and cough were related to asthma only in obese women. Activity-related dyspnea was very prevalent (MRC score > 1, 75%), associated with obesity, with the exception of wheezing on exertion due to asthma. Asymptomatic AHR and SDB did not affect dyspneic complaints.
CONCLUSIONS:In severely obese women referred for bariatric surgery, resting dyspnea complaints are observed in association with asthma or GERD, while activity-related dyspnea was mainly related to obesity only. Consequently, asthma does not explain all respiratory complaints of obese women.
