COPDへのリハ栄養RCT

COPDに対するリハ栄養の有効性を検証したRCTを紹介します。

Gurgun A, Deniz S, Argın M, Karapolat H.　The Effects of Nutritional Supplementation Combined with Conventional Pulmonary Rehabilitation in Muscle Wasted Chronic Obstructive Pulmonary Disease: A Prospective, Randomised and Controlled Study.　Respirology. 2012 Nov 20. doi: 10.1111/resp.12019. [Epub ahead of print]

リサーチクエスチョンは以下の通りです。

P：COPD患者に
I：呼吸リハ＋栄養療法を行うと
C：呼吸リハ単独、もしくはコントロールと比較して
O：一次アウトカムは不明ですが、筋肉量、筋力、呼吸困難、運動能力、QOL、不安、抑うつが改善する
D：RCT

結果ですが、リハ栄養群および呼吸リハ群で、呼吸困難、QOL、6分間歩行距離、抑不安が有意に改善しました。抑うつは不変でした。体重、除脂肪体重も両群とも有意に増加しています。BMIと大腿筋面積はリハ栄養群のみ、有意に改善しました。

以上よりCOPDに対する呼吸リハ＋栄養療法（リハ栄養）は有用という結論です。

抄録しか読めていませんので詳細不明ですが、結果の改善はすべて、対照群との比較ではなく、前後比較となっています。そのため、これらの改善が本当に意味があるのかどうかは抄録だけでは何ともいえません。ただ、COPDのリハ栄養が有効かつ重要なことは確かだと思っています。

Abstract

BACKGROUND AND OBJECTIVE:

Nutritional depletion in COPD adversly affects health status and mortality. We aimed to evaluate the effects of nutritional supplementation (NS) with pulmonary rehabilitation (PR) on body composition, mid-thigh cross-sectional area (CSA), dyspnea, exercise capacity, HRQoL, anxiety and depression in advanced COPD patients.

METHODS:

Forty-six patients were randomised to PRNS, PR or the control group. Dyspnea was measured with Medical Research Council (MRC) and BORG scales. Exercise capacity was measured through 6MWT and shuttle tests, HRQoL was assessed with SGRQ. Psychological status was measured with Hospital Anxiety and Depression Scale. Body weight and body mass indexes were also evaluated. Fat free mass was measured through bioelectrical impedance analyzer. The CSA of quadriceps was calculated in mid-level of the thigh with magnetic resonance imaging.

RESULTS:

Dyspnea and total scores of SGRQ improved in both groups (p<0 .05=".05" 0.1="0.1" 0.2="0.2" 0.6="0.6" 43.3="43.3" 63.3="63.3" 69.3="69.3" 6mwt="6mwt" a="a" after="after" although="although" and="and" anxiety="anxiety" as="as" bmi="bmi" body="body" both="both" change="change" cm="cm" csa="csa" depression.="depression." distances="distances" ffmi="ffmi" groups="groups" improved="improved" in="in" increase="increase" increased="increased" intervention.="intervention." iswt="iswt" kg="kg" m="m" mid-thigh="mid-thigh" no="no" only="only" p="0.04).</p" patients="patients" pr="pr" prns="prns" significant="significant" significantly="significantly" the="the" there="there" was="was" weight="weight" whereas="whereas">

CONCLUSIONS:

The combination of NS with PR resulted in improvements particularly in lean body mass and mid-thigh CSA. This study suggests combining NS with PR in reversing weight loss and muscle wasting in COPD.