充血性心力衰竭患者运动时的氨反应。

Ammonia response to exercise in patients with congestive heart failure.

作者信息

Ogino K, Osaki S, Kitamura H, Noguchi N, Hisatome I, Matsumoto T, Omodani H, Kato M, Kinugawa T, Miyakoda H, Kotake H, Mashiba H

机构信息

First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.

出版信息

Heart. 1996 Apr;75(4):343-8. doi: 10.1136/hrt.75.4.343.

DOI:10.1136/hrt.75.4.343

PMID:8705758

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC484307/

Abstract

OBJECTIVE

To assess energy depletion in skeletal muscle in patients with congestive heart failure by measuring blood purine metabolites during exercise and, at the same time, determine the implications of the ammonia response to exercise in these patients.

SETTING

Tottori University Hospital, Yonago, Japan.

PATIENTS

49 heart failure patients (New York Heart Association (NYHA) grades I-III) and 16 normal subjects.

MAIN OUTCOME MEASURES

Blood lactate, ammonia, and hypoxanthine levels were measured during exercise with expired gas analysis.

RESULTS

In normal exercising subjects as well as in each heart failure subgroup, the ammonia threshold was significantly higher than both the lactate threshold [control: 21.8 (SD 5.3) v 17.4 (3.3) ml/kg/min; NYHA class I: 18.9 (3.8) v 15.5 (2.6); class II: 14.8 (2.5) v 12.7 (2.4); class III: 13.5 (2.6) v 11.8 (2.5)] and the ventilatory threshold (P < 0.01). The difference between the ammonia and lactate thresholds was noted in all normal subjects and in all heart failure patients. The ammonia threshold, however, was significantly lower in heart failure patients than in normal subjects and it decreased with increasing NYHA class (P < 0.01). Maximum ammonia levels were lower in the heart failure group and decreased further with higher NYHA classifications [control: 198 (52) mg/dl; NYHA class I: 170 (74); class II: 134 (58); class III: 72 (15); P < 0.01]. There were significant correlations between maximum ammonia values and maximum lactate, oxygen consumption, and hypoxanthine levels (r = 0.74, 0.48, and 0.87, respectively; P < 0.001).

CONCLUSIONS

The ammonia threshold may reflect the onset of ATP depletion in exercising skeletal muscles, as opposed to the onset of anaerobic respiration. It seems therefore that energy depletion in skeletal muscles during exercise occurs after attaining the anaerobic threshold. Both aerobic and anaerobic capacities of skeletal muscle are reduced in patients with congestive heart failure.

摘要

目的

通过测量运动期间血液嘌呤代谢产物，评估充血性心力衰竭患者骨骼肌中的能量消耗，同时确定这些患者运动时氨反应的意义。

设置

日本米子市鸟取大学医院。

患者

49例心力衰竭患者（纽约心脏协会（NYHA）分级I - III级）和16名正常受试者。

主要观察指标

运动期间通过呼出气体分析测量血乳酸、氨和次黄嘌呤水平。

结果

在正常运动受试者以及每个心力衰竭亚组中，氨阈值显著高于乳酸阈值[对照组：21.8（标准差5.3）对17.4（3.3）ml/kg/min；NYHA I级：18.9（3.8）对15.5（2.6）；II级：14.8（2.5）对12.7（2.4）；III级：13.5（2.6）对11.8（2.5）]和通气阈值（P < 0.01）。所有正常受试者和所有心力衰竭患者均观察到氨阈值与乳酸阈值之间的差异。然而，心力衰竭患者的氨阈值显著低于正常受试者，且随NYHA分级增加而降低（P < 0.01）。心力衰竭组的最大氨水平较低，且随着NYHA分级升高进一步降低[对照组：198（52）mg/dl；NYHA I级：170（74）；II级：134（58）；III级：72（15）；P < 0.01]。最大氨值与最大乳酸、耗氧量和次黄嘌呤水平之间存在显著相关性（r分别为0.74、0.48和0.87；P < 0.001）。