肺纤维化合并肺气肿患者的心肺运动试验。

Cardiopulmonary Exercise Testing in Combined Pulmonary Fibrosis and Emphysema.

机构信息

Department of Pneumology, Sleep and Respiratory Medicine, Hemer Lung Clinic, Hemer, Germany,

University Witten/Herdecke, Witten, Germany,

出版信息

Respiration. 2021;100(5):395-403. doi: 10.1159/000513848. Epub 2021 Mar 3.

DOI:10.1159/000513848

PMID:33657565

Abstract

BACKGROUND

Combined pulmonary fibrosis and emphysema (CPFE) is a distinct entity among fibrosing lung diseases with a high risk for lung cancer and pulmonary hypertension (PH). Notably, concomitant PH was identified as a negative prognostic indicator that could help with early diagnosis to provide important information regarding prognosis.

OBJECTIVES

The current study aimed to determine whether cardiopulmonary exercise testing (CPET) can be helpful in differentiating patients having CPFE with and without PH.

METHODS

Patients diagnosed with CPFE in 2 German cities (Hemer and Greifswald) over a period of 10 years were included herein. CPET parameters, such as peak oxygen uptake (peak VO2), functional dead space ventilation (VDf/VT), alveolar-arterial oxygen difference (AaDO2), arterial-end-tidal CO2 difference [P(a-ET)CO2] at peak exercise, and the minute ventilation-carbon dioxide production relationship (VE/VCO2 slope), were compared between patients with and without PH.

RESULTS

A total of 41 patients with CPET (22 with PH, 19 without PH) were analyzed. Right heart catheterization was performed in 15 of 41 patients without clinically relevant complications. Significant differences in peak VO2 (861 ± 190 vs. 1,397 ± 439 mL), VO2/kg body weight/min (10.8 ± 2.6 vs. 17.4 ± 5.2 mL), peak AaDO2 (72.3 ± 7.3 vs. 46.3 ± 14.2 mm Hg), VE/VCO2 slope (70.1 ± 31.5 vs. 39.6 ± 9.6), and peak P(a-ET)tCO2 (13.9 ± 3.5 vs. 8.1 ± 3.6 mm Hg) were observed between patients with and without PH (p < 0.001). Patients with PH had significantly higher VDf/VT at rest, VT1, and at peak exercise (65.6 ± 16.8% vs. 47.2 ± 11.6%; p < 0.001) than those without PH. A cutoff value of 44 for VE/VCO2 slope had a sensitivity and specificity of 94.7 and 72.7%, while a cutoff value of 11 mm Hg for P(a-ET)CO2 in combination with peak AaDO2 >60 mm Hg had a specificity and sensitivity of 95.5 and 84.2%, respectively. Combining peak AaDO2 >60 mm Hg with peak VO2/body weight/min <16.5 mL/kg/min provided a sensitivity and specificity of 100 and 95.5%, respectively.

CONCLUSION

This study provided initial data on CPET among patients having CPFE with and without PH. CPET can help noninvasively detect PH and identify patients at risk. AaDO2 at peak exercise, VE/VCO2 slope, peak P(a-ET)CO2, and peak VO2 were parameters that had high sensitivity and, when combined, high specificity.

摘要

背景

在纤维化性肺部疾病中，合并性肺纤维化和肺气肿（CPFE）是一种独特的实体，存在发生肺癌和肺动脉高压（PH）的高风险。值得注意的是，并发 PH 被认为是一个负面预后指标，可以帮助早期诊断，提供预后的重要信息。

目的

本研究旨在确定心肺运动测试（CPET）是否有助于区分 CPFE 患者中是否存在 PH。

方法

纳入在德国两个城市（黑默尔和格赖夫斯瓦尔德）在 10 年内诊断为 CPFE 的患者。比较了有和无 PH 的患者的 CPET 参数，如峰值摄氧量（peak VO2）、功能性死腔通气（VDf/VT）、肺泡-动脉氧差（AaDO2）、峰值运动时的动脉-呼气末二氧化碳差 [P(a-ET)CO2] 和分钟通气-二氧化碳产量关系（VE/VCO2 斜率）。

结果

分析了 41 名接受 CPET 的患者（22 名有 PH，19 名无 PH）。在没有临床相关并发症的 41 名患者中，有 15 名接受了右心导管检查。有 PH 的患者的峰值 VO2（861 ± 190 比 1,397 ± 439 mL）、VO2/kg 体重/min（10.8 ± 2.6 比 17.4 ± 5.2 mL）、峰值 AaDO2（72.3 ± 7.3 比 46.3 ± 14.2 mmHg）、VE/VCO2 斜率（70.1 ± 31.5 比 39.6 ± 9.6）和峰值 P(a-ET)tCO2（13.9 ± 3.5 比 8.1 ± 3.6 mmHg）之间存在显著差异（p < 0.001）。有 PH 的患者的静息、VT1 和峰值运动时的 VDf/VT 明显更高（65.6 ± 16.8% 比 47.2 ± 11.6%；p < 0.001）。VE/VCO2 斜率的截断值为 44 时具有 94.7%的敏感性和 72.7%的特异性，而 P(a-ET)CO2 的截断值为 11 mmHg 与峰值 AaDO2 >60 mmHg 相结合时具有 95.5%的特异性和 84.2%的敏感性。将峰值 AaDO2 >60 mmHg 与峰值 VO2/体重/min <16.5 mL/kg/min 相结合可分别提供 100%和 95.5%的敏感性和特异性。