[特发性肺动脉高压患者心肺运动试验的临床观察]

[Clinical observation of cardiopulmonary exercise test in patients with idiopathic pulmonary arterial hypertension].

作者信息

Luo Qin, Liu Zhi-hong, Ma Xiu-ping, Zhao Zhi-hui, Gu Qing, Xiong Chang-ming, Ni Xin-hai, He Jian-guo, Zhao Qing

机构信息

State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2013 Jun 11;93(22):1683-6.

PMID:24124671

Abstract

OBJECTIVE

To explore the exercise characteristics of patients with idiopathic pulmonary arterial hypertension (IPAH).

METHODS

From November 2010 to September 2012 , 76 consecutive IPAH patients and 24 healthy controls from Fuwai Cardiovascular Hospital were enrolled to undergo cardiopulmonary exercise testing. The exercise parameters were compared. Correlations among peak oxygen consumption, anaerobic threshold, peak oxygen pulse, New York Heart Association (NYHA) class, N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walking distance (6 MWD) and cardiac index are analyzed in IPAH.

RESULTS

There were 21 males and 55 females in IPAH and 8 males and 16 females in controls. Their mean ages were (31.5 ± 10.6) and (35.5 ± 6.4) years respectively. Significant differences (P = 0.000) existed between two groups in peak oxygen consumption ((12.7 ± 3.3) vs (25.6 ± 5.8) ml·min(-1)·kg(-1)), anaerobic threshold ((9.8 ± 2.5) vs (16.7 ± 3.9) ml·min(-1)·kg(-1)), peak oxygen pulse ((5.3 ± 1.6) vs (9.9 ± 2.5) ml/bpm) and ventilator efficiency (slope of minute ventilation in relation to CO2 produced) ((42.6 ± 2.0) vs (25.5 ± 3.5)). In IPAH, peak oxygen consumption was significantly correlated with NYHA class (r = -0.509, P = 0.000), 6 MWD (r = 0.443, P = 0.002) and NT-proBNP levels (r = -0.423, P = 0.011). And anaerobic threshold was significantly correlated with NYHA class (r = -0.362, P = 0.002), 6MWD (r = 0.343, P = 0.004) and NT-proBNP levels (r = -0.275, P = 0.017). Peak oxygen pulse and ventilator efficiency were both correlated well with total pulmonary vascular resistance. Partial correlation analysis demonstrated that there were significant correlations among peak oxygen consumption, anaerobic threshold, NYHA class, NT-proBNP levels and 6MWD after adjusting for age, gender and weight.

CONCLUSIONS

Peak oxygen consumption and anaerobic threshold decrease ventilator efficiency in IPAH patients. Cardiopulmonary exercise testing is an invasive tool of assessing safely the function of IPAH patients.

摘要

目的

探讨特发性肺动脉高压（IPAH）患者的运动特征。

方法

2010年11月至2012年9月，连续纳入76例IPAH患者和24例来自阜外心血管病医院的健康对照者进行心肺运动试验。比较运动参数。分析IPAH患者的峰值耗氧量、无氧阈、峰值氧脉搏、纽约心脏协会（NYHA）心功能分级、N末端脑钠肽前体（NT-proBNP）、6分钟步行距离（6MWD）和心脏指数之间的相关性。

结果

IPAH组中男性21例，女性55例；对照组中男性8例，女性16例。他们的平均年龄分别为（31.5±10.6）岁和（35.5±6.4）岁。两组在峰值耗氧量（（12.7±3.3）对（25.6±5.8）ml·min⁻¹·kg⁻¹）、无氧阈（（9.8±2.5）对（16.7±3.9）ml·min⁻¹·kg⁻¹）、峰值氧脉搏（（5.3±1.6）对（9.9±2.5）ml/次心跳）和通气效率（分钟通气量与二氧化碳产生量的斜率）（（42.6±2.0）对（25.5±3.5））方面存在显著差异（P = 0.000）。在IPAH患者中，峰值耗氧量与NYHA心功能分级（r = -0.509，P = 0.000）、6MWD（r = 0.443，P = 0.002）和NT-proBNP水平（r = -0.423，P = 0.011）显著相关。无氧阈与NYHA心功能分级（r = -0.362，P = 0.002）、6MWD（r = 0.343，P = 0.004）和NT-proBNP水平（r = -0.275，P = 0.017）显著相关。峰值氧脉搏和通气效率均与总肺血管阻力密切相关。偏相关分析表明，在调整年龄、性别和体重后，峰值耗氧量、无氧阈、NYHA心功能分级、NT-proBNP水平和6MWD之间存在显著相关性。