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(Chest. 2003;124:83-89.)
© 2003 American College of Chest Physicians

Catabolic/Anabolic Balance and Muscle Wasting in Patients With COPD*

Richard Debigaré, PhD; Karine Marquis, MSc; Claude H. Côté, PhD; Roland R. Tremblay, MD, PhD; Annie Michaud, MSc; Pierre LeBlanc, MD and François Maltais, MD

* From the Centre de Recherche (Drs. Debigaré, LeBlanc, and Maltais, and Ms. Marquis and Ms. Michaud), Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, and the Centre de Recherche du Centre Hospitalier Universitaire de Quebéc Pavillon Centre Hospitalier de l’Université Laval (Drs. Côté and Tremblay), Université Laval, Sainte-Foy, QC, Canada.

Correspondence to: François Maltais, MD, Centre de Pneumologie, Hôpital Laval, 2725 Chemin Ste-Foy, Ste-Foy, QC, Canada, G1V 4G5

Backgroud: The mechanisms leading to muscle wasting in patients with COPD are still uncertain. This study was undertaken to evaluate the relationships among circulating levels of catabolic factors (ie, interleukin [IL]-6 and cortisol), anabolic factors (ie, bioavailable testosterone [Tbio], dehydroepiandrosterone sulfate [DHEAS], and insulin-like growth factor [IGF]-I), and mid-thigh muscle cross-sectional area (MTCSA) in patients with COPD.

Methods: Serum levels of the above factors were measured in 45 men with COPD (mean [± SEM] FEV1, 43 ± 3% predicted; mean age, 67 ± 1 years) and 16 sedentary healthy men of similar age. MTCSA was quantified using CT scanning. Patients with COPD were subdivided into two groups according to the MTCSA (< 70 or >= 70 cm2).

Results: There was a greater prevalence of hypogonadism (ie, Tbio, < 2 nmol/L) in patients with COPD compared to control subjects (22% vs 0%, respectively). Patients with an MTCSA of < 70 cm2 had significantly reduced levels of DHEAS compared to those in healthy subjects (p < 0.01). IL-6 levels were significantly higher in both subgroups of COPD patients compared to those in control subjects (p < 0.005). The cortisol/DHEAS, IL-6/DHEAS, IL-6/Tbio, and IL-6/IGF-I ratios were significantly greater in COPD patients with an MTCSA of < 70 cm2 compared to those in control subjects (p < 0.05). The cortisol/DHEAS and IL-6/DHEAS ratios were also significantly greater in COPD patients with an MTCSA of < 70 cm2 than in COPD patients with an MTCSA of >= 70 cm2 (p < 0.05). In a stepwise multiple regression analysis, the IL-6/DHEAS ratio explained 20% of the variance in MTCSA (p < 0.005).

Conclusion: Catabolic/anabolic disturbances were found in COPD patients leading to a shift toward catabolism and possibly to the development of peripheral muscle wasting.

Key Words: atrophy • COPD • cytokines • insulin-like growth factor-I • muscle • testosterone • wasting




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