Martolini Dario, Tanner Rebecca, Davey Claire, Patel Mehul S, Elia Davide, Purcell Helen, Palange Paolo, Hopkinson Nicholas S, Polkey Michael I
National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, United Kingdom.
Laboratory of Respiratory Pathophysiology, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
Chronic Obstr Pulm Dis. 2014 Sep 25;1(2):185-192. doi: 10.15326/jcopdf.1.2.2013.0003.
Patent foramen ovale (PFO) is a common finding in adults. A PFO is associated with right to left shunting but its importance in the aetiology of hypoxia in early COPD remains uncertain, although it has not proved possible to demonstrate a role for PFOs in the aetiology of hypoxia in patients with Global Initiative for chronic Obstructive Lung Disease (GOLD) stage III/IV disease. We compared the characteristics of GOLD stage II patients with or without a PFO and assessed its impact on exercise performance. In 22 GOLD stage II COPD patients we measured exercise performance, arterial oxygen tension and lung function and used contrast transcranial Doppler ultrasonography (TCD) to assess the presence of a PFO. Patients (n=20) underwent TCD measurements during incremental cycle ergometry with respiratory pressures measured using an esophageal balloon catheter (n=13). Twelve individuals (54%) had a PFO. Patients with a PFO were more hypoxic; mean(SD) partial pressure of oxygen in arterial blood (PaO)10.2(1.1) kilopascals (kPa) 11.7(0.9)kPa (p<0.01), but the presence of a PFO was not associated with reduced exercise performance either on cycle ergometry or a 6 Minute Walk Test (6MWT). A strong relationship was noted between the esophageal pressure swing (P) and the degree of shunting observed during exercise (r=0.7; p<0.001). The presence of a PFO in GOLD stage II COPD patients does not appear to influence exercise performance despite increased right-to-left shunting.
卵圆孔未闭（PFO）在成年人中很常见。PFO与右向左分流有关，但其在慢性阻塞性肺疾病（COPD）早期低氧血症病因中的重要性仍不确定，尽管尚未证明PFO在全球慢性阻塞性肺疾病倡议（GOLD）III/IV期患者低氧血症病因中起作用。我们比较了有或没有PFO的GOLD II期患者的特征，并评估了其对运动表现的影响。在22例GOLD II期COPD患者中，我们测量了运动表现、动脉血氧张力和肺功能，并使用经颅多普勒超声造影（TCD）评估PFO的存在情况。患者（n = 20）在递增式运动心肺功能测试期间接受TCD测量，同时使用食管气囊导管测量呼吸压力（n = 13）。12名个体（54%）存在PFO。有PFO的患者缺氧更严重；动脉血氧分压（PaO）的平均值（标准差）为10.2（1.1）千帕（kPa），而无PFO患者为11.7（0.9）kPa（p<0.01），但PFO的存在与运动心肺功能测试或6分钟步行试验（6MWT）中的运动表现降低无关。观察到食管压力波动（P）与运动期间观察到的分流程度之间存在密切关系（r = 0.7；p<0.001）。尽管右向左分流增加，但GOLD II期COPD患者中PFO的存在似乎并不影响运动表现。
