Thirapatarapong Wilawan, Armstrong Hilary F, Bartels Matthew N
Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand; Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, NY, NY 10032 USA.
Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, NY, NY 10032 USA.
Heart Lung Circ. 2014 Sep;23(9):833-40. doi: 10.1016/j.hlc.2013.12.015. Epub 2014 Jan 31.
To determine; (i) the effect of PH on exercise capacity, gas exchange and oxygen pulse; (ii) the variables that correlate with mean pulmonary artery pressure (mPAP) in severe COPD patients.
We reviewed 98 severe COPD patients who had pulmonary function, right heart catheterisation, and cardiopulmonary exercise testing (CPET) performed within six months of each other. PH was defined by a resting mPAP > 25 mmHg. COPD patients with and without PH were compared using the independent samples t-test and Mann-Whitney U test. Pearson correlation coefficients were used to assess the relationship between continuous variables.
PH was present in 32% of patients and the majority of PH was mild (mPAP, 25-35 mmHg). Peak workload, oxygen uptake and oxygen pulse on CPET were significantly lower in the PH group. Mean PAP was found to inversely correlate with peak oxygen uptake, with a tendency towards lower six-minute walk distance. No difference between two groups was seen in any of the gas exchange variables.
In severe COPD, there is a relatively high percentage of PH which causes a decrease in exercise capacity and oxygen pulse without significantly altered ventilation as measured by CPET. Lower than expected exercise performance without a change in pulmonary function may indicate a need for evaluation for possible PH.
确定；（i）pH值对运动能力、气体交换和氧脉搏的影响；（ii）与重度慢性阻塞性肺疾病（COPD）患者平均肺动脉压（mPAP）相关的变量。
我们回顾了98例重度COPD患者，他们在彼此6个月内进行了肺功能、右心导管检查和心肺运动试验（CPET）。pH值定义为静息mPAP>25 mmHg。使用独立样本t检验和曼-惠特尼U检验对有和无pH值的COPD患者进行比较。Pearson相关系数用于评估连续变量之间的关系。
32%的患者存在pH值，且大多数pH值为轻度（mPAP，25 - 35 mmHg）。CPET上的峰值工作量、摄氧量和氧脉搏在pH值组显著更低。发现平均PAP与峰值摄氧量呈负相关，六分钟步行距离有降低趋势。两组在任何气体交换变量上均未观察到差异。
在重度COPD中，pH值的发生率相对较高，其导致运动能力和氧脉搏降低，而CPET测量的通气无显著改变。肺功能无变化但运动表现低于预期可能表明需要评估是否存在可能的pH值。
