动态肺过度充气对稳定期慢性阻塞性肺疾病患者运动能力和生活质量的影响。

Effects of dynamic hyperinflation on exercise capacity and quality of life in stable COPD patients.

作者信息

Zhao Li, Peng Liyue, Wu Baomei, Bu Xiaoning, Wang Chen

机构信息

Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Beijing, China.

Department of Surgery Intensive Care Unit, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Clin Respir J. 2016 Sep;10(5):579-88. doi: 10.1111/crj.12260. Epub 2015 Mar 2.

DOI:10.1111/crj.12260

PMID:25620462

Abstract

BACKGROUND AND AIMS

Dynamic hyperinflation (DH) is an important pathophysiological characteristic of chronic obstructive pulmonary disease (COPD). There is increasing evidence that DH has negative effects on exercise performance and quality of life. The objective of this study was to explore effects of DH on exercise capacity and quality of life in stable COPD patients.

METHODS

Fifty-eight COPD patients and 20 matched healthy individuals underwent pulmonary function test, 6-min walk test and symptom-limited cardiopulmonary exercise test (CPET). End-expiratory lung volume/total lung capacity ratio (EELVmax/TLC) at peak exercise of CPET was evaluated, and EELVmax/TLC ≥ 75% was defined as 'severe dynamic hyperinflation (SDH)'.

RESULTS

Of the 58 patients studied, 29 (50.0%) presented with SDH (SDH+ group, EELVmax/TLC 79.60 ± 3.60%), having worse maximal exercise capacity reflected by lower peakload, maximal oxygen uptake (VO2 max), maximal carbon dioxide output (VCO2 max) and maximal minute ventilation (VEmax) than did those without SDH (SDH- group, EELVmax/TLC 67.44 ± 6.53%). The EELVmax/TLC ratio at peak exercise had no association with variables of pulmonary function and 6-min walk distance (6MWD), but correlated inversely with peakload, VO2 max, VCO2 max and VEmax (r = -0.300~-0.351, P < 0.05). Although no significant differences were observed, patients with EELVmax/TLC ≥ 75% tended to have higher COPD assessment test score (15.07 ± 6.55 vs 13.28 ± 6.59, P = 0.303).

CONCLUSIONS

DH develops variably during exercise and has a greater impact on maximal exercise capacity than 6MWD, even in those with the same extent of pulmonary function impairment at rest.

摘要

背景与目的

动态肺过度充气（DH）是慢性阻塞性肺疾病（COPD）的一项重要病理生理特征。越来越多的证据表明，DH对运动能力和生活质量有负面影响。本研究的目的是探讨DH对稳定期COPD患者运动能力和生活质量的影响。

方法

58例COPD患者和20例匹配的健康个体接受了肺功能测试、6分钟步行试验和症状限制心肺运动试验（CPET）。评估CPET运动峰值时的呼气末肺容积/肺总量比值（EELVmax/TLC），EELVmax/TLC≥75%被定义为“严重动态肺过度充气（SDH）”。

结果

在研究的58例患者中，29例（50.0%）出现SDH（SDH+组，EELVmax/TLC 79.60±3.60%），与无SDH的患者（SDH-组，EELVmax/TLC 67.44±6.53%）相比，其最大运动能力更差，表现为峰值负荷、最大摄氧量（VO2 max）、最大二氧化碳排出量（VCO2 max）和最大分钟通气量（VEmax）更低。运动峰值时的EELVmax/TLC比值与肺功能变量和6分钟步行距离（6MWD）无关，但与峰值负荷、VO2 max、VCO2 max和VEmax呈负相关（r = -0.300~-0.351，P < 0.05）。尽管未观察到显著差异，但EELVmax/TLC≥75%的患者COPD评估测试得分往往更高（15.07±6.55对13.28±6.59，P = 0.303）。