Beaven Michael L, Gibbons James T D, Course Christopher W, Kotecha Sarah J, Hixson Thomas, Maiorana Andrew, Zuidersma Melissa, Kotecha Sailesh, Smith Elizabeth F, Simpson Shannon J
Curtin School of Allied Health, Curtin University, Perth, Australia.
Children's Lung Health, Wal-yan Respiratory Research Centre, The Kids Research Institute Australia, Perth, Australia.
Eur Respir Rev. 2025 Jun 18;34(176). doi: 10.1183/16000617.0163-2024. Print 2025 Apr.
Survivors of preterm birth (<37 weeks' gestation) have low peak oxygen uptake, a global measure of aerobic fitness and an established predictor of increased morbidity and mortality. However, little is known about other cardiopulmonary outcome measures in this population. We addressed the hypothesis that preterm birth is associated with abnormal respiratory, cardiovascular and metabolic responses to exercise, as assessed by cardiopulmonary exercise testing, a systematic review and meta-analysis.
Six databases were systematically searched up to 29 November 2024 (PROSPERO: CRD42022320775). Studies reporting cardiopulmonary outcome measures obtained during a standardised exercise test were included if they had preterm-born participants and matched term-born controls. The standardised mean difference (SMD) between pooled preterm-born and term-born cohorts was calculated using random-effects models for the meta-analysis.
Of the 12 143 records identified, 47 cohorts were included in the final meta-analysis. At peak exercise, the preterm-born cohort (n=2149) demonstrated lower oxygen uptake (SMD -0.39, 95% CI -0.52 to -0.26), work rate (SMD -0.53, 95% CI -0.70 to -0.35), minute ventilation (SMD -0.43, 95% CI -0.60 to -0.26), tidal volume (SMD -0.38, 95% CI -0.62 to -0.15), oxygen pulse (SMD -0.47, 95% CI -0.75 to -0.19), heart rate (SMD -0.18, 95% CI -0.28 to -0.07), anaerobic threshold (SMD -0.29, 95% CI -0.49 to -0.08) and gas exchange efficiency (SMD 0.22, 95% CI 0.04 to 0.41), compared to the term-born cohort (n=1650).
In addition to a reduced peak oxygen uptake, survivors of preterm birth have impairments in the respiratory, cardiovascular and metabolic domains during cardiopulmonary exercise testing. Given that reduced aerobic capacity is associated with increased morbidity and mortality, exercise interventions that target cardiorespiratory fitness should be prioritised across the lifespan in those born preterm.
早产（妊娠<37周）幸存者的峰值摄氧量较低，这是衡量有氧适能的一项综合指标，也是发病率和死亡率增加的既定预测指标。然而，对于该人群的其他心肺结局指标知之甚少。我们通过心肺运动测试、系统评价和荟萃分析验证了这一假设，即早产与运动时异常的呼吸、心血管和代谢反应有关。
截至2024年11月29日，系统检索了六个数据库（PROSPERO：CRD42022320775）。纳入报告在标准化运动测试中获得的心肺结局指标的研究，条件是研究中有早产参与者和匹配的足月出生对照。使用随机效应模型计算汇总的早产队列和足月出生队列之间的标准化平均差（SMD），用于荟萃分析。
在检索到的12143条记录中，最终的荟萃分析纳入了47个队列。与足月出生队列（n = 1650）相比，在运动峰值时，早产队列（n = 2149）的摄氧量较低（SMD -0.39，95%CI -0.52至-0.26）、工作率较低（SMD -0.53，95%CI -0.70至-0.35）、分钟通气量较低（SMD -0.43，95%CI -0.60至-0.26）、潮气量较低（SMD -0.38，95%CI -0.62至-0.15）、氧脉搏较低（SMD -0.47，95%CI -0.75至-0.19）、心率较低（SMD -0.18，95%CI -0.28至-0.07）、无氧阈值较低（SMD -0.29，95%CI -0.49至-0.08）以及气体交换效率较高（SMD 0.22，95%CI 0.04至0.41）。
除了峰值摄氧量降低外，早产幸存者在心肺运动测试期间，呼吸、心血管和代谢方面也存在功能障碍。鉴于有氧能力降低与发病率和死亡率增加相关，对于早产出生者，应在其整个生命周期优先考虑针对心肺适能的运动干预措施。
