运动期间的二氧化碳潴留是否预示着囊性纤维化患者的第一秒用力呼气容积（FEV1）下降更快？

Does carbon dioxide retention during exercise predict a more rapid decline in FEV1 in cystic fibrosis?

作者信息

Javadpour S M, Selvadurai H, Wilkes D L, Schneiderman-Walker J, Coates A L

机构信息

Department of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.

出版信息

Arch Dis Child. 2005 Aug;90(8):792-5. doi: 10.1136/adc.2004.070110.

DOI:10.1136/adc.2004.070110

PMID:16040875

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1720533/

Abstract

BACKGROUND

Carbon dioxide (CO2) retention during exercise is uncommon in mild to moderate lung disease in cystic fibrosis (CF). The ability to deal with increased CO2 is dependent on the degree of airflow limitation and inherent CO2 sensitivity. CO2 retention (CO2R) can be defined as a rise in P(ET)CO2 tension of > or =5 mm Hg with exercise together with a failure to reduce P(ET)CO2 tension after peak work by at least 3 mm Hg by the termination of exercise.

AIM

To ascertain if carbon dioxide retention during exercise is associated with more rapid decline in lung function.

METHODS

Annual spirometric and exercise data from 58 children aged 11-15 years, with moderate CF lung disease between 1996 and 2002 were analysed.

RESULTS

The mean FEV1 at baseline for the two groups was similar; the CO2R group (n = 15) was 62% and the non-CO2 retention group (CO2NR) was 64% (n = 43). The decline in FEV1 after 12 months was -3.2% (SD 1.1) in the CO2R group and -2.3% (SD 0.9) in the CO2NR group. The decline after 24 months was -6.3% (SD 1.3) and -1.8% (SD 1.1) respectively. After 36 months, the decline in FEV1 was -5.3% (SD 1.2) and -2.6% (SD 1.1) respectively. The overall decline in lung function was 14.8% (SD 2.1) in the CO2R group and 6.7% (SD 1.8) in the CO2NR group. Using the primary outcome measure as a decline in FEV(1) of >9%, final multivariate analysis showed that the relative risks for this model were (95% CIs in parentheses): DeltaP(ET)CO2 11.61 (3.41 to 24.12), peak VO2 1.23 (1.10 to 1.43), and initial FEV(1) 1.14 (1.02 to 1.28).

CONCLUSION

Results show that the inability to defend carbon dioxide during exercise is associated with a more rapid decline in lung function.

摘要

背景

在囊性纤维化（CF）的轻至中度肺部疾病中，运动期间二氧化碳（CO₂）潴留并不常见。应对增加的CO₂的能力取决于气流受限程度和内在的CO₂敏感性。CO₂潴留（CO₂R）可定义为运动时呼气末二氧化碳分压（P(ET)CO₂）升高≥5 mmHg，且运动结束时未能使P(ET)CO₂分压在运动峰值后至少降低3 mmHg。

目的

确定运动期间二氧化碳潴留是否与肺功能更快速下降相关。

方法

分析了1996年至2002年间58名年龄在11 - 15岁、患有中度CF肺部疾病儿童的年度肺功能和运动数据。

结果

两组的基线平均第一秒用力呼气容积（FEV₁）相似；CO₂R组（n = 15）为62%，非CO₂潴留组（CO₂NR）为64%（n = 43）。12个月后，CO₂R组的FEV₁下降了-3.2%（标准差1.1），CO₂NR组下降了-2.3%（标准差0.9）。24个月后的下降分别为-6.3%（标准差1.3）和-1.8%（标准差1.1）。36个月后，FEV₁的下降分别为-5.3%（标准差1.2）和-2.6%（标准差1.1）。CO₂R组的肺功能总体下降为14.8%（标准差2.1），CO₂NR组为6.7%（标准差1.8）。将主要结局指标设定为FEV₁下降>9%，最终多因素分析显示该模型的相对风险为（括号内为95%置信区间）：△P(ET)CO₂为11.61（3.41至24.12），峰值摄氧量（peak VO₂）为1.23（1.10至1.43），初始FEV₁为1.14（1.02至1.28）。