Reinsma G D, ten Hacken N H T, Grevink R G, van der Bij W, Koëter G H, van Weert E
Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Heart Lung Transplant. 2006 Nov;25(11):1310-6. doi: 10.1016/j.healun.2006.08.008.
After lung transplantation (LTx) exercise capacity frequently remains limited, despite significantly improved pulmonary function. The aim of this study was to evaluate maximal exercise capacity and peripheral muscle force before and 1 year after LTx, and to determine whether peripheral muscle force and lactate threshold (LT) limit exercise capacity 1 year after LTx.
Twenty-five subjects (mean age 43 years, 8 women and 17 men, 4 single-lung transplantations) were included in the study. Measurements included maximal exercise capacity, lactate threshold (symptom-limited bicycle ergometer test) and muscle force test (hand-held dynamometer) were performed before and 1 year after LTx.
Before LTx, all patients showed severe exercise intolerance (mean +/- SD): work capacity (W(peak)), 11.6 +/- 18 W; peak oxygen uptake (Vo(2)), 8.6 +/- 3.6 ml/min/kg. After LTx, exercise capacity improved significantly: W(peak), 69 +/- 27 W (p < 0.001); peak Vo(2), 15.7 +/- 4.3 ml/min/kg (p < 0.001). Ventilatory factors did not appear to limit exercise capacity. Quadriceps muscle force pre- vs post-LTx was: 248 +/- 73 N vs 281 +/- 68 N (p < 0.05). Post-LTx, a significant correlation was found between LT and exercise capacity (r = 0.76, p < 0.001), between muscle force and exercise capacity (r = 0.41, p < 0.05) and between the LT and muscle force (r = 0.53, p < 0.01).
The occurrence of an early and pathologic LT and peripheral muscle weakness contributes to the limitation of exercise capacity and reflects a peripheral deficit post-LTx.
肺移植（LTx）后，尽管肺功能显著改善，但运动能力常常仍受限。本研究的目的是评估肺移植前及肺移植后1年的最大运动能力和外周肌肉力量，并确定外周肌肉力量和乳酸阈值（LT）是否限制肺移植后1年的运动能力。
本研究纳入了25名受试者（平均年龄43岁，8名女性和17名男性，4例单肺移植）。测量内容包括最大运动能力、乳酸阈值（症状限制自行车测力计测试）和肌肉力量测试（手持测力计），在肺移植前及肺移植后1年进行。
肺移植前，所有患者均表现出严重的运动不耐受（平均值±标准差）：工作能力（W(peak)），11.6±18 W；峰值摄氧量（Vo(2)），8.6±3.6 ml/min/kg。肺移植后，运动能力显著改善：W(peak)，69±27 W（p<0.001）；峰值Vo(2)，15.7±4.3 ml/min/kg（p<0.001）。通气因素似乎并未限制运动能力。肺移植前后股四头肌力量分别为：248±73 N对281±68 N（p<0.05）。肺移植后，发现乳酸阈值与运动能力之间存在显著相关性（r = 0.76，p<0.001），肌肉力量与运动能力之间存在显著相关性（r = 0.41，p<0.05），乳酸阈值与肌肉力量之间存在显著相关性（r = 0.53，p<0.01）。
早期病理性乳酸阈值的出现和外周肌肉无力导致运动能力受限，并反映了肺移植后的外周功能缺陷。
