Distribuição segmentar da massa magra em pacientes com doença pulmonar obstrutiva crônica
Data
2015-08-31
Autores
Rocco, Carolina Chiusoli de Miranda 
Orientadores
Jardim, Jose Roberto de Brito
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A perda muscular periférica observada na DPOC está associada à pior prognóstico e à redução da sobrevida. Não está ainda elucidada a contribuição da massa magra dos membros superiores para a massa muscular total nestes pacientes. Objetivos: O objetivo deste estudo foi avaliar pela densitometria por absorção de duplo feixe de raios X (DXA) a distribuição da massa muscular nos membros superiores, membros inferiores e tronco de pacientes com DPOC e avaliar a força muscular específica dos membros superiores e inferiores. Métodos: Em um estudo transversal, 96 pacientes com DPOC e 85 idosos sem doença pulmonar do grupo controle, pareados pela idade e sexo, foram avaliados quanto à função pulmonar, composição corporal e força muscular periférica dos membros superiores (dinamometria) e inferiores (1 repetição máxima). Resultados: A idade média dos pacientes com DPOC foi de 66,8 (± 9,3) e do grupo controle de 64,2 (± 8,9) anos (p = 0,064), com IMC de 27,2 (± 5,1) e 29,4 (± 4,5) kg/m2, respectivamente (p = 0,002). Não houve diferença quantitativa de massa magra entre os grupos, em qualquer segmento corporal; no entanto o percentual de gordura foi maior no grupo controle, tanto nos membros superiores, membros inferiores e tronco (p < 0,05). O índice apendicular de massa magra (IAMM) (valores normais: ? 7,26 kg/m2 para homens e ? 5,45 kg/m2 para mulheres) foi menor nos homens com DPOC (7,8 kg/m2 ± 1,1) do que no grupo controle (8,4 kg/m2 ± 0,9) (p > 0,05); e foi menor nos pacientes com DPOC grave e muito grave em relação aos com a doença leve a moderada (7,5 vs 8,0 kg/m2 para homens e 6,1 vs 6,8 kg/m2 para mulheres, respectivamente). Houve correlação positiva moderada da massa magra dos membros superiores (r = 0,5) e membros inferiores (r = 0,6) com a força muscular. A força específica dos membros superiores (0,115 ± 0,003 kgf/g de músculo vs 0,134 ± 0,004 kgf/g de músculo) e dos membros inferiores (0,015 ± 0,001 kg/g de músculo vs 0,018 ± 0,001 kg/g de músculo) dos pacientes com DPOC foi menor que a do grupo controle (p < 0,001). Embora tenhamos identificado 26,8% dos homens e 12,5% das mulheres com baixa massa muscular no grupo DPOC, apenas 7 homens (12,5%) e 3 mulheres (7,5%) foram diagnosticados como sarcopênicos. Conclusão: O índice apendicular de massa magra identificado pela DXA está diminuído nos pacientes com DPOC e a perda da massa muscular aumenta na doença avançada. A força muscular específica está reduzida nos pacientes com DPOC.
INTRODUCTION: Peripheral muscle loss observed in COPD is associated with poor prognosis and reduced survival. It is not yet elucidated the contribution of lean mass of the upper limbs for total muscle mass in these patients. OBJECTIVES: The aim of this study was to evaluate by dual X-ray beam absorption (DXA) the distribution of muscle mass in upper limbs, lower limbs and trunk of patients with COPD and to assess the specific strength of the upper and lower limbs. METHODS: In a crosssectional study with 96 COPD patients and 85 elderly people without lung disease as control group, matched for age and sex, were evaluated for lung function, body composition and peripheral muscle strength of the upper limbs (dynamometer) and lower limbs (1 repetition maximum). RESULTS: The mean age of patients with COPD was 66.8 years (± 9.3) and control group was 64.2 (± 8.9) years (p = 0.064), with a BMI of 27.2 (± 5.1) and 29.4 (± 4.5) kg/m2 , respectively (p = 0.002). There was no quantitative difference in lean body mass between the groups in any of the segments of the body; however the percentage of fat was higher in control group in both upper limbs, lower limbs and trunk (p <0.05). The appendicular lean mass index (IAMM) (normal range: ≥ 7.26 kg/m2 for men and ≥ 5.45 kg/m2 for women) was lower in men with COPD (7.8 kg/m2 ± 1.1) than in the control group (8.4 kg/m2 ± 0.9) (p>0.05); and it was lower in patients with severe or very severe COPD compared to those with mild to moderate disease (7.5 vs 8.0 kg/m for men and 6.1 vs 6.8 kg/m2 for women, respectively). There was a moderate positive correlation between lean mass of the upper limbs (r = 0.5) and lower limbs (r = 0.6) with muscle strength. The specific strength of the upper limbs (0.115 ± 0.003 kgf/g muscle vs 0.134 ± 0.004 kgf/g muscle) and lower limbs (0.015 ± 0.001 kg/g muscle vs 0.018 ± 0.001 kg/g muscle) of COPD patients were lower than the control group (p <0.001). Although we have identified 26.8% of men and 12.5% of women with low muscle mass in COPD, only 7 men (12.5%) and 3 women (7.5%) were diagnosed as sarcopenic. CONCLUSION: The appendicular lean mass index identified by DXA is decreased in patients with COPD and this loss of muscle mass increases in advanced disease. The specific muscle strength is reduced in patients with COPD.
INTRODUCTION: Peripheral muscle loss observed in COPD is associated with poor prognosis and reduced survival. It is not yet elucidated the contribution of lean mass of the upper limbs for total muscle mass in these patients. OBJECTIVES: The aim of this study was to evaluate by dual X-ray beam absorption (DXA) the distribution of muscle mass in upper limbs, lower limbs and trunk of patients with COPD and to assess the specific strength of the upper and lower limbs. METHODS: In a crosssectional study with 96 COPD patients and 85 elderly people without lung disease as control group, matched for age and sex, were evaluated for lung function, body composition and peripheral muscle strength of the upper limbs (dynamometer) and lower limbs (1 repetition maximum). RESULTS: The mean age of patients with COPD was 66.8 years (± 9.3) and control group was 64.2 (± 8.9) years (p = 0.064), with a BMI of 27.2 (± 5.1) and 29.4 (± 4.5) kg/m2 , respectively (p = 0.002). There was no quantitative difference in lean body mass between the groups in any of the segments of the body; however the percentage of fat was higher in control group in both upper limbs, lower limbs and trunk (p <0.05). The appendicular lean mass index (IAMM) (normal range: ≥ 7.26 kg/m2 for men and ≥ 5.45 kg/m2 for women) was lower in men with COPD (7.8 kg/m2 ± 1.1) than in the control group (8.4 kg/m2 ± 0.9) (p>0.05); and it was lower in patients with severe or very severe COPD compared to those with mild to moderate disease (7.5 vs 8.0 kg/m for men and 6.1 vs 6.8 kg/m2 for women, respectively). There was a moderate positive correlation between lean mass of the upper limbs (r = 0.5) and lower limbs (r = 0.6) with muscle strength. The specific strength of the upper limbs (0.115 ± 0.003 kgf/g muscle vs 0.134 ± 0.004 kgf/g muscle) and lower limbs (0.015 ± 0.001 kg/g muscle vs 0.018 ± 0.001 kg/g muscle) of COPD patients were lower than the control group (p <0.001). Although we have identified 26.8% of men and 12.5% of women with low muscle mass in COPD, only 7 men (12.5%) and 3 women (7.5%) were diagnosed as sarcopenic. CONCLUSION: The appendicular lean mass index identified by DXA is decreased in patients with COPD and this loss of muscle mass increases in advanced disease. The specific muscle strength is reduced in patients with COPD.
Descrição
Citação
ROCCO, Carolina Chiusoli de Miranda. Distribuição segmentar da massa magra em pacientes com doença pulmonar obstrutiva crônica. 2015. 84 f. Tese (Doutorado em Medicina Translacional) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.