通过半自动一氧化碳重复呼吸评估姿势性直立性心动过速综合征中的血容量不足。
Blood volume deficit in postural orthostatic tachycardia syndrome assessed by semiautomated carbon monoxide rebreathing.
作者信息
Kulapatana Surat, Urechie Vasile, Rigo Stefano, Mohr Abigail, Vance Yuliya A, Okamoto Luis E, Gamboa Alfredo, Shibao Cyndya, Biaggioni Italo, Furlan Raffaello, Diedrich André
机构信息
Autonomic Dysfunction Center, Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, 1161 21 Avenue South, Suite S3116 MCN, Nashville, TN, 37232‑2600, USA.
Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
出版信息
Clin Auton Res. 2025 Apr;35(2):267-276. doi: 10.1007/s10286-024-01091-8. Epub 2024 Nov 30.
PURPOSE
The semiautomated carbon monoxide (CO) rebreathing method has been introduced as a noninvasive and radiation-free blood volume estimation method. We tested whether the semiautomated CO rebreathing method can detect the blood volume deficit in postural orthostatic tachycardia syndrome (POTS). In addition, we explored the relationship between blood volume estimated from CO rebreathing and body impedance.
PATIENTS AND METHODS
We recruited 53 subjects (21 female patients with POTS, 19 healthy female participants, and 13 healthy male participants) to record blood volumes and hemodynamic data. Blood volumes were measured by CO rebreathing and segmental body impedance. Linear regression models to predict normal values of red blood cell volume (RBCV), plasma volume (PV), and total blood volume (BV) were developed. Percentage deviations from the predicted normal volumes were calculated.
RESULTS
Patients with POTS had lower RBCV (25.18 ± 3.95 versus 28.57 ± 3.68 mL/kg, p = 0.008, patients with POTS versus healthy female participants), BV (64.53 ± 10.02 versus 76.78 ± 10.00 mL/kg, p < 0.001), and BV deviation (-13.92 ± 10.38% versus -0.02 ± 10.18%, p < 0.001). Patients with POTS had higher supine heart rate (HR) (84 ± 14 versus 69 ± 11 bpm, p < 0.001) and upright HR (123 ± 23 versus 89 ± 22 bpm, p < 0.001). We found a correlation between BV deviation and upright HR in patients with POTS (r = -0.608, p = 0.003), but not in healthy participants. Volumes from the CO rebreathing and body impedance were well correlated (r = 0.629, p < 0.001).
CONCLUSIONS
The CO rebreathing method can detect BV deficit, as well as the RBCV deficit in patients with POTS. The negative correlation between BV deviation and upright HR indicates that hypovolemia is one of the pathophysiological causes of POTS. Correlations between body impedance and CO rebreathing volume suggest its usefulness for measurements of volume changes.
目的
半自动一氧化碳（CO）重呼吸法已作为一种无创且无辐射的血容量估算方法被引入。我们测试了半自动CO重呼吸法能否检测出体位性直立性心动过速综合征（POTS）患者的血容量不足。此外，我们还探究了通过CO重呼吸估算的血容量与身体阻抗之间的关系。
患者与方法
我们招募了53名受试者（21名POTS女性患者、19名健康女性参与者和13名健康男性参与者）来记录血容量和血流动力学数据。通过CO重呼吸和分段身体阻抗测量血容量。建立了预测红细胞体积（RBCV）、血浆体积（PV）和总血容量（BV）正常值的线性回归模型。计算了与预测正常体积的百分比偏差。
结果
POTS患者的RBCV较低（25.18±3.95对28.57±3.68 mL/kg，p = 0.008，POTS患者对健康女性参与者），BV较低（64.53±10.02对76.78±10.00 mL/kg，p < 0.001），BV偏差较大（-13.92±10.38%对-0.02±10.18%，p < 0.001）。POTS患者的仰卧心率（HR）较高（84±14对69±11次/分钟，p < 0.001），直立HR较高（123±23对89±22次/分钟，p < 0.001）。我们发现POTS患者的BV偏差与直立HR之间存在相关性（r = -0.608，p = 0.003），但在健康参与者中未发现。CO重呼吸法测得的体积与身体阻抗之间相关性良好（r = 0.629，p < 0.001）。
结论
CO重呼吸法能够检测出POTS患者的BV不足以及RBCV不足。BV偏差与直立HR之间的负相关性表明血容量不足是POTS的病理生理原因之一。身体阻抗与CO重呼吸体积之间的相关性表明其在测量体积变化方面具有实用性。
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