Yuan Ping, Chen Tian-Xiang, Pudasaini Bigyan, Zhang Jie, Guo Jian, Zhang Si-Jin, Wang Lan, Zhao Qin-Hua, Gong Su-Gang, Jiang Rong, Wu Wen-Hui, He Jing, Liu Jin-Ming, Hu Qing-Hua
Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
The Organization and Personnel Department, Qilu Children's Hospital of Shandong University, Shandong University, Shandong, China.
Ther Adv Respir Dis. 2017 Mar;11(3):135-145. doi: 10.1177/1753465816684424. Epub 2017 Jan 2.
Many studies have highlighted sex preponderance in idiopathic pulmonary arterial hypertension (IPAH). It is well established that there are differences in exercise capacities in the two sexes but how much of that difference reflects on disease severity or correlates to markers of severity in the two sexes is still not clear. Right heart catheterization (RHC) and cardiopulmonary exercise testing (CPET) have been widely used for assessing functional capacity, prognosis and treatment response in IPAH. We aimed to investigate the 'sex-specific' CPET parameters in relation to hemodynamics in IPAH.
Data were retrieved from 30 males and 53 females [mean ± standard deviation (SD) age: 39.6 ± 17.2 and 37.5 ± 12.0] stable IPAH patients who underwent both RHC and CPET at Shanghai Pulmonary Hospital from 2010 to 2016. Univariate and forward/backward multiple stepwise regression analysis was performed to assess the prognostic value of CPET and hemodynamic parameters.
There were no significant differences in clinical variables between men and women. Peak workload, peak oxygen uptake, anaerobic threshold (AT), peak minute ventilation, carbon dioxide output, O pulse and oxygen uptake efficiency slope were significantly higher in men compared with women ( p < 0.05). Several CPET indexes correlated with hemodynamics. Pulmonary vascular resistance (PVR) and cardiac output (CO) were distinctly different between the sexes. Peak end-tidal partial pressure of CO (PCO) was an independent predictor of PVR elevation in all patients and in men. Peak maximum oxygen consumption (VO) was independently predictive of CO decline in all patients and in men. Only peak O pulse was an independent predictor of increased PVR and decreased CO in women.
Even after adjusting for age, body mass index and World Health Organization functional class, different CPET parameters correlated with PVR elevation and CO decline in men and women differently, which could potentially better predict severity in men and women with IPAH.
许多研究都强调了特发性肺动脉高压（IPAH）存在性别差异。众所周知，两性在运动能力方面存在差异，但这种差异在多大程度上反映疾病严重程度或与两性的严重程度标志物相关仍不清楚。右心导管检查（RHC）和心肺运动试验（CPET）已被广泛用于评估IPAH患者的功能能力、预后和治疗反应。我们旨在研究IPAH中与血流动力学相关的“性别特异性”CPET参数。
从2010年至2016年在上海肺科医院接受RHC和CPET检查的30例男性和53例女性[平均±标准差（SD）年龄：39.6±17.2岁和37.5±12.0岁]稳定期IPAH患者中获取数据。进行单因素和向前/向后多步回归分析以评估CPET和血流动力学参数的预后价值。
男性和女性的临床变量无显著差异。男性的峰值工作量、峰值摄氧量、无氧阈值（AT）、峰值分钟通气量、二氧化碳排出量、O脉搏和摄氧效率斜率均显著高于女性（p<0.05）。几个CPET指标与血流动力学相关。两性之间的肺血管阻力（PVR）和心输出量（CO）明显不同。呼气末二氧化碳分压（PCO）峰值是所有患者和男性中PVR升高的独立预测因子。最大摄氧量（VO）峰值是所有患者和男性中CO下降的独立预测因子。只有O脉搏峰值是女性中PVR升高和CO下降的独立预测因子。
即使在调整年龄、体重指数和世界卫生组织功能分级后，不同的CPET参数与男性和女性的PVR升高和CO下降的相关性不同，这可能更好地预测IPAH男性和女性的严重程度。
