Pediatric Pulmonology and Cystic Fibrosis Unit, Aristotle University of Thessaloniki School of Health Sciences, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece.
Radiology Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
Pediatr Pulmonol. 2019 Oct;54(10):1584-1590. doi: 10.1002/ppul.24438. Epub 2019 Jul 5.
Exercise ventilation efficiency index in cardiopulmonary exercise testing (CPET) is elevated in patients with heart failure providing useful information on disease progression and prognosis. Few data, however, exist for ventilation efficiency index among cystic fibrosis (CF) patients.
To assess ventilation efficiency index (ΔVE/ΔVCO or V'E/V'CO slope) and intercept of ventilation (VE-intercept) in CF patients with mild, moderate, and severe cystic fibrosis (CF) lung disease. To assess possible correlations with ventilation inhomogeneity and structural damages as seen on high resolution computed tomography (HRCT).
CF patients with mild (FEV > 80%, n = 47), moderate (60% < FEV < 80%, n = 21), and severe (FEV < 60%, n = 9) lung disease, mean age 14.9 years participated. Peak oxygen uptake (VO peak), pulmonary ventilation at peak exercise (VE), respiratory equivalent ratios for oxygen and carbon dioxide at peak exercise (VE/VO , VE/VCO ), end-tidal CO (PetCO ), and ΔVE/ΔVCO , ΔVE/ΔVO in a maximal CPET along with spirometry and multiple breath washout indices were examined. HRCT scans were performed and scored using Bhalla score.
Mean ΔVE/ΔVCO showed no significant differences among the three groups (P = .503). Mean VE discriminated significantly among the different groups (p < 0.001). Ventilation efficiency index did not correlate either with LCI or Bhalla score. However, VE together with ΔVE/ΔVCO slope could predict Bhalla score (r = 0.869, P = .006).
No significant differences were found regarding ΔVE/ΔVCO slope levels between the three groups. Ventilation intercept (VE ) was elevated significantly as disease progresses reflecting increased dead space ventilation. CF patients retain their ventilation efficiency to exercise even as lung function deteriorates by adopting a higher respiratory rate along with increased dead space ventilation.
心肺运动试验（CPET）中的运动通气效率指数在心力衰竭患者中升高，为疾病进展和预后提供了有用的信息。然而，囊性纤维化（CF）患者的通气效率指数数据很少。
评估轻度、中度和重度 CF 肺病患者的通气效率指数（ΔVE/ΔVCO 或 V'E/V'CO 斜率）和通气截距（VE 截距）。评估与高分辨率计算机断层扫描（HRCT）所见通气不均匀性和结构损伤的可能相关性。
纳入 47 例 FEV>80%（轻度 CF 肺病）、21 例 60%<FEV<80%（中度 CF 肺病）和 9 例 FEV<60%（重度 CF 肺病）的 CF 患者，平均年龄 14.9 岁。测量峰值摄氧量（VO peak）、峰值运动时的肺通气（VE）、峰值运动时的氧和二氧化碳呼吸当量比（VE/VO 、VE/VCO ）、呼气末 CO（PetCO ）、最大 CPET 中的ΔVE/ΔVCO、ΔVE/ΔVO ，以及肺量计和多次呼吸冲洗指数。进行 HRCT 扫描，并使用 Bhalla 评分进行评分。
三组间平均ΔVE/ΔVCO 无显著差异（P=0.503）。平均 VE 在不同组间有显著差异（p<0.001）。通气效率指数与 LCI 或 Bhalla 评分均无相关性。然而，VE 与ΔVE/ΔVCO 斜率可以预测 Bhalla 评分（r=0.869，P=0.006）。
三组间ΔVE/ΔVCO 斜率水平无显著差异。随着疾病的进展，通气截距（VE）显著升高，反映出死腔通气的增加。CF 患者在肺功能恶化的情况下仍能保持运动时的通气效率，通过增加呼吸频率和死腔通气来实现。
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