Zhao Qing, Liu Zhihong, Ma Xiuping, Zhao Zhihui, Luo Qin, Gu Qing, Xiong Changming, Zhang Hongliang, Wang Yong
Center for Pulmonary Vascular Disease Diagnosis and Treatment, State Key Laboratory of Cardiovascalar Disease, Fuwai Hospital, National Center for Cardiovascalar Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Center for Pulmonary Vascular Disease Diagnosis and Treatment, State Key Laboratory of Cardiovascalar Disease, Fuwai Hospital, National Center for Cardiovascalar Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Email:
Zhonghua Yi Xue Za Zhi. 2015 Nov 24;95(44):3598-601.
To assess the exercise capacity of three kinds of pulmonary artery hypertension using cardiopulmonary exercise testing (CPET).
In the Center for Pulmonary Vascular Disease Diagnosis and Treatment of Fuwai Hospital, idiopathic pulmonary artery hypertension (IPAH), congenital heart disease associated pulmonary artery hypertension (CHD-PAH), connective tissue disease associated pulmonary artery hypertension (CTD-PAH) were enrolled into this study from December 2012 to May 2013. CPET was performed in all patients, and clinical features, routine tests results, N-terminal B-type natriuretic peptide (NT-proBNP), Six-minutes-walk distance (6MWD) were all collected.
Thirty-two patients with IPAH, 38 patients with CHD-PAH, 25 patients with CTD-PAH were enrolled. For IPAH, CHD-PAH, and CTD-PAH patients, the peak oxygen uptake via body weight (VO₂max/kg) was (12.3 ± 2.3), (14.9 ± 4.0), and (11.1 ± 2.5) ml·min⁻¹·kg⁻¹, respectively. The peak VO₂/kg was significantly different within these three groups (P<0.001), and was significantly higher in CHD-PAH patients compared with the other two groups (P=0.003, P<0.001). The peak VO2/heart rate (HR) was (5.8±1.4), (6.4 ± 1.8), (5.3 ± 1.7) ml·beat(-1)·min⁻¹ in the above three groups and was significantly different within these three groups (P=0.034). The peak VO₂/HR was significantly increased in CHD-PAH patients than CTD-PAD patients (P=0.012). The peak HR was (136.1 ± 21.4), (140.8 ± 19.9), (124.5 ± 21.6) beat/min respectively and was significantly lower in CTD-PAD patients than CHD-PAH patients (P=0.009). The 6MWD was significantly decreased in CTD-PAD patients compared with CHD-PAH and IPAH patients (P=0.006, 0.010). Nt-proBNP was significantly decreased in CTD-PAD patients compared with CHD-PAH patients (P=0.012). In Pearson and partial correlation analysis, the peak VO₂/kg was significantly correlated with peak VO₂/HR, peak HR, 6MWD, Nt-proBNP, left ventricular end-diastolic diameter, right ventricular end-diastolic diameter (r=0.477, 0.518, 0.387, 0.465, -0.350, 0.349, -0.259).
CPET parameters can objectively evaluate exercise capacity and cardiopulmonary function of the patients with pulmonary hypertension.
采用心肺运动试验（CPET）评估三种类型肺动脉高压患者的运动能力。
2012年12月至2013年5月，在北京阜外医院肺血管病诊断与治疗中心，纳入特发性肺动脉高压（IPAH）、先天性心脏病相关性肺动脉高压（CHD-PAH）、结缔组织病相关性肺动脉高压（CTD-PAH）患者进行本研究。对所有患者进行CPET检查，并收集其临床特征、常规检查结果、N末端B型利钠肽原（NT-proBNP）、六分钟步行距离（6MWD）。
共纳入32例IPAH患者、38例CHD-PAH患者、25例CTD-PAH患者。IPAH、CHD-PAH、CTD-PAH患者的每公斤体重最大摄氧量（VO₂max/kg）分别为（12.3±2.3）、（14.9±4.0）、（11.1±2.5）ml·min⁻¹·kg⁻¹。三组间VO₂/kg峰值差异有统计学意义（P<0.001），CHD-PAH患者的VO₂/kg峰值显著高于其他两组（P=0.003，P<0.001）。上述三组的每搏量最大摄氧量（VO₂/心率）分别为（5.8±1.4）、（6.4±1.8）、（5.3±1.7）ml·beat(-1)·min⁻¹，三组间差异有统计学意义（P=0.034）。CHD-PAH患者的VO₂/心率峰值显著高于CTD-PAD患者（P=0.012）。三组的最高心率分别为（136.1±21.4）、（140.8±19.9）、（124.5±21.6）次/分钟，CTD-PAD患者的最高心率显著低于CHD-PAH患者（P=0.009）。与CHD-PAH和IPAH患者相比，CTD-PAD患者的6MWD显著降低（P=0.006，0.010）。与CHD-PAH患者相比，CTD-PAD患者的Nt-proBNP显著降低（P=0.012）。在Pearson和偏相关分析中，VO₂/kg峰值与VO₂/心率峰值、最高心率、6MWD、Nt-proBNP、左心室舒张末期内径、右心室舒张末期内径显著相关（r=⁃0.477、0.518、0.387、0.465、⁃0.350、0.349、⁃0.259）。
CPET参数可客观评估肺动脉高压患者的运动能力和心肺功能。
