在 6 分钟步行试验中，氧饱和度动态反应受损与慢性纤维化间质性肺病的死亡率相关。
Impaired Dynamic Response of Oxygen Saturation During the 6-min Walk Test Is Associated With Mortality in Chronic Fibrosing Interstitial Pneumonia.
机构信息
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan; and Division of Rehabilitation, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
Division of Rehabilitation, Chiba University Hospital, Chiba, Japan.
出版信息
Respir Care. 2023 Mar;68(3):356-365. doi: 10.4187/respcare.10231.
BACKGROUND
The 6-min walk test (6MWT) is a common assessment of exercise-induced hypoxemia and exercise capacity used in patients with chronic fibrosing interstitial pneumonia (CFIP). However, whether the dynamic changes in S and heart rate during the 6MWT are associated with mortality in patients with CFIP has been undefined.
METHODS
This retrospective study enrolled 63 subjects with mild to severe CFIP who underwent the 6MWT. Subjects with CFIP were divided into 2 groups according to disease severity: mild, diffusing capacity of the lungs for carbon monoxide percentage predicted (%D) > 55% and %FVC > 75%; and severe, %D ≤ 55% and/or %FVC ≤ 75%. This study aimed to evaluate dynamic changes in the 6MWT including 6-min walk distance, change in S (ΔS ), S reduction time, S recovery time, change in heart rate (Δ heart rate), heart rate acceleration time, slope of heart rate acceleration, heart rate recovery at 1 min of rest after the 6MWT (HR-recovery), and dyspnea on exertion that are reflected by static pulmonary function and are related to exacerbation of CFIP and mortality.
RESULTS
Compared with subjects with mild CFIP, subjects with severe CFIP had significantly larger ΔS and longer S reduction time and recovery time. The slope of heart rate, heart rate immediately after the 6MWT, and HR-recovery were lower in subjects with severe CFIP than in those with mild CFIP. In multiple regression analysis, percent vital capacity was significantly associated with S reduction time, and %D was significantly associated with ΔS and S recovery time. Subjects with ΔS of > 10% and S recovery time of > 79 s had a significantly higher risk for exacerbation and mortality.
CONCLUSIONS
Dynamic changes in S and heart rate during the 6MWT were associated with risk for exacerbation and mortality in subjects with CFIP. Impaired dynamic response of S could reflect likelihood of exacerbation and increased mortality in CFIP.
背景
6 分钟步行试验（6MWT）是一种常用于慢性纤维化间质性肺炎（CFIP）患者的评估运动诱导性低氧血症和运动能力的常用方法。然而，在 CFIP 患者中，6MWT 过程中 S 和心率的动态变化是否与死亡率相关尚未确定。
方法
这项回顾性研究纳入了 63 名轻至重度 CFIP 患者，他们均接受了 6MWT。根据疾病严重程度将 CFIP 患者分为两组：轻度，一氧化碳弥散量占预计值百分比（%D）>55%和 %FVC>75%；重度，%D ≤ 55%和/或 %FVC ≤ 75%。本研究旨在评估 6MWT 中的动态变化，包括 6 分钟步行距离、S 的变化（ΔS）、S 降低时间、S 恢复时间、心率变化（Δ心率）、心率加速时间、心率加速斜率、6MWT 后 1 分钟休息时的心率恢复（HR-recovery）以及静息时的呼吸困难，这些反映了 CFIP 加重和死亡率相关的静态肺功能。
结果
与轻度 CFIP 患者相比，重度 CFIP 患者的 ΔS 更大，S 降低时间和恢复时间更长。重度 CFIP 患者的心率斜率、6MWT 后即刻心率和 HR-recovery 均低于轻度 CFIP 患者。多元回归分析显示，肺活量百分比与 S 降低时间显著相关，%D 与 ΔS 和 S 恢复时间显著相关。ΔS 大于 10%和 S 恢复时间大于 79s 的患者 CFIP 加重和死亡的风险显著增加。
结论
在 CFIP 患者中，6MWT 过程中 S 和心率的动态变化与 CFIP 加重和死亡风险相关。S 的动态反应受损可能反映 CFIP 加重的可能性和死亡率的增加。
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