[结节病合并心脏受累患者的6分钟步行试验]

Kowalska Anna, Puścińska Elżbieta, Goljan-Geremek Anna, Czerniawska Justyna, Stokłosa Anna, Kram Marek, Tomkowski Witold Z, Górecka Dorota

II Klinika Chorób Płuc, Instytut Gruźlicy i Chorób Płuc, ul. Płocka 26, 01–138 Warszawa.

Pneumonol Alergol Pol. 2012;80(5):430-8.

INTRODUCTION

Cardiac involvement in sarcoidosis is of critical importance, due to the poor prognosis if this organ manifestation is left undiagnosed and untreated. The six-minute walk test (6 MWT) is a useful test to evaluate exercise tolerance of sarcoid patients. We aimed to assess the 6 MWT value in diagnosis, course and treatment monitoring of patients with cardiac sarcoidosis.

MATERIAL AND METHODS

47 patients were included: 22 with pulmonary sarcoidosis and cardiac involvement (13 women, 9 men), 25 with pulmonary sarcoidosis, with no changes in the heart (15 women, 10 men), and 18 healthy volunteers as controls (12 women, 6 men). Out of 22 patients with cardiac involvement 11 were treated for heart sarcoidosis with prednisone (9 pts - initial dose 60 mg daily and 2 pts - 40 mg daily). 11 pts in this group were not treated. In all patients sarcoidosis was confirmed histopatologically. Magnetic resonance imaging was used to diagnose involvement of the heart. In the studied groups we assessed: heart rate (HR), oxygen saturation, and distance in 6 MWT and Borg dyspnea score.

RESULTS

Patients with cardiac sarcoidosis desaturated more during exercise (DSaO2max = 3.5 ± 3.2 vs. 0.38 ± 0.69; p = 0.004) and had a lower increase of HR in first minute during the 6 MWT (DHR1 = 21.81 ± 11.72 vs. 50.61 ± 12.35; p = 0.0001) when compared to healthy subjects. Significantly lower increase of HR in first minute of 6 MWT was observed in patients with cardiac sarcoidosis when compared to patients with pulmonary sarcoidosis with no cardiac involvement (DHR1 = 21.81 ± 11.72 vs. 38.8 ± 18.17, p = 0.01). After introduction of treatment in sarcoidosis group, significantly higher (p = 0.02) increase of HR in first minute of 6 MWT as compared to baseline test was observed.

CONCLUSIONS

The six-minute walk test is useful in diagnosing cardiac involvement in sarcoidosis. The increase in HR during exercise and decrease degree of desaturation were a good predictors of the response to therapy.

引言

结节病累及心脏至关重要，因为若这种器官表现未被诊断和治疗，预后较差。六分钟步行试验（6MWT）是评估结节病患者运动耐力的一项有用测试。我们旨在评估6MWT值在心脏结节病患者诊断、病程及治疗监测中的作用。

材料与方法

纳入47例患者：22例为肺部结节病伴心脏受累（13例女性，9例男性），25例为肺部结节病但心脏无改变（15例女性，10例男性），18名健康志愿者作为对照（12例女性，6例男性）。在22例心脏受累患者中，11例接受泼尼松治疗心脏结节病（9例初始剂量为每日60mg，2例为每日40mg）。该组中11例未接受治疗。所有患者的结节病均经组织病理学确诊。使用磁共振成像诊断心脏受累情况。在研究组中，我们评估了：心率（HR）、血氧饱和度、6MWT中的步行距离以及Borg呼吸困难评分。

结果

与健康受试者相比，心脏结节病患者运动期间血氧饱和度下降更明显（最大血氧饱和度下降值[DSaO2max] = 3.5±3.2 vs. 0.38±0.69；p = 0.004），且在6MWT第一分钟内心率升高幅度更低（第一分钟心率增加值[DHR1] = 21.81±11.72 vs. 50.61±12.35；p = 0.0001）。与无心脏受累的肺部结节病患者相比，心脏结节病患者在6MWT第一分钟内心率升高幅度明显更低（DHR1 = 21.81±11.72 vs. 38.8±18.17，p = 0.01）。结节病组开始治疗后，与基线测试相比，6MWT第一分钟内心率升高幅度明显更高（p = 0.02）。