Gao Beiyao, Wang Siyuan, Zhao Li, Liao Hongbin, Qumu Shiwei, Wang Peijian, Yang Ting, Jiang Shan
Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Department of Lung Transplantation, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Jul 14;20:2381-2391. doi: 10.2147/COPD.S513089. eCollection 2025.
To identify predictive factors for different exercise-induced desaturation (EID) severities and evaluate health-related quality of life six months later in chronic obstructive pulmonary disease (COPD) patients.
This retrospective study consecutively analyzed 116 COPD outpatients (male: 82.8% [96/116]; age: 63.48 ± 7.48 years; disease severity distribution: GOLD 1/2/3/4 = 55.8%/34.6%/7.7%/1.9%). Patients were categorized into three groups based on oxygen desaturation (SpO) during the six-minute walk test (6MWT): non-EID (n = 52), mild-EID (n = 42), and severe-EID (n = 22). EID was classified as follows: Mild EID: SpO decrease ≥4% with nadir SpO ≥90%. Severe EID: SpO decrease ≥4% with nadir SpO ≤90%. Non EID: SpO decrease <4% with nadir SpO ≥90%. A six-month follow-up was conducted via telephone to record adverse events and assess quality of life using the Chinese version of the EQ-5D questionnaire, which includes five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, along with the EQ-VAS scale.
Significant differences were observed across the three groups in peripheral blood oxygen saturation (SpO, %), peak expiratory flow (PEF, L/s), PEF (%), forced expiratory volume in the first second (FEV1, L), FEV1 (%), 6MWT distance (6MWD, m), Borg dyspnea, and Borg fatigue scores. The optimal cutoff values for predicting EID severity was 54.45% for FEV1% (AUC=0.716), 450.5 m for 6MWD (AUC = 0.761), and 94.5% for resting SpO (AUC = 0.737). Multivariate logistic regression analysis identified low FEV1%, reduced 6MWD, and low resting SpO as risk factors for severe EID (FEV1%: p = 0.002; 6MWD: p = 0.008; SpO: p = 0.018. Severe EID patients had significantly lower EQ-5D index and EQ-VAS scores (EQ-5D index: p = 0.002; EQ-VAS: P = 0.005), particularly in mobility and usual activities dimensions (mobility: p = 0.001; usual activities: p = 0.038).
Low FEV1%, reduced 6MWD, and low resting SpO are key risk factors for severe EID, provide practical thresholds for clinical management of EID in COPD patients.
确定慢性阻塞性肺疾病（COPD）患者不同运动诱发低氧血症（EID）严重程度的预测因素，并在6个月后评估其健康相关生活质量。
这项回顾性研究连续分析了116例COPD门诊患者（男性：82.8%[96/116]；年龄：63.48±7.48岁；疾病严重程度分布：GOLD 1/2/3/4 = 55.8%/34.6%/7.7%/1.9%）。根据6分钟步行试验（6MWT）期间的氧饱和度（SpO₂）将患者分为三组：无EID（n = 52）、轻度EID（n = 42）和重度EID（n = 22）。EID分类如下：轻度EID：SpO₂下降≥4%且最低SpO₂≥90%。重度EID：SpO₂下降≥4%且最低SpO₂≤90%。无EID：SpO₂下降<4%且最低SpO₂≥90%。通过电话进行6个月随访，记录不良事件，并使用中文版EQ-5D问卷评估生活质量，该问卷包括五个维度：活动能力、自我护理、日常活动、疼痛/不适和焦虑/抑郁，以及EQ-VAS量表。
三组在外周血氧饱和度（SpO₂，%）、呼气峰值流速（PEF，L/s）、PEF（%）、第1秒用力呼气量（FEV₁，L）、FEV₁（%）、6MWT距离（6MWD，m）、Borg呼吸困难评分和Borg疲劳评分方面存在显著差异。预测EID严重程度的最佳截断值为：FEV₁%为54.45%（AUC = 0.716），6MWD为450.5 m（AUC = 0.761），静息SpO₂为94.5%（AUC = 0.737）。多因素逻辑回归分析确定低FEV₁%、6MWD降低和静息SpO₂低是重度EID的危险因素（FEV₁%：p = 0.002；6MWD：p = 0.008；SpO₂：p = 0.018）。重度EID患者的EQ-5D指数和EQ-VAS评分显著较低（EQ-5D指数：p = 0.002；EQ-VAS：P = 0.005），尤其是在活动能力和日常活动维度（活动能力：p = 0.001；日常活动：p = 0.038）。
低FEV₁%、6MWD降低和静息SpO₂低是重度EID的关键危险因素，为COPD患者EID的临床管理提供了实用的阈值。
