中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
32期
2490-2494
,共5页
史小芳%刘锦铭%郭健%杨文兰%刘辉%黄丹丹%吴常伟%宫素岗%赵勤华%何晶%王岚
史小芳%劉錦銘%郭健%楊文蘭%劉輝%黃丹丹%吳常偉%宮素崗%趙勤華%何晶%王嵐
사소방%류금명%곽건%양문란%류휘%황단단%오상위%궁소강%조근화%하정%왕람
高血压,肺性%运动试验%心脏导管插入术%次极量运动
高血壓,肺性%運動試驗%心髒導管插入術%次極量運動
고혈압,폐성%운동시험%심장도관삽입술%차겁량운동
Hypertension,pulmonary%Exercise test%Heart catheterization%Submaximal exercise
目的:探讨肺动脉高压患者次极量运动参数与峰值摄氧量( P-VO2)的相关性。方法回顾性分析2010年10月至2013年10月在同济大学附属上海市肺科医院住院治疗的106例肺动脉高压患者(肺动脉高压组)的临床资料,包括肺功能、氨基末端脑利钠肽前体( NT-proBNP )测定、6 min步行试验、右心导管检查及心肺运动试验的结果资料,并以同期无吸烟史、无心肺疾病及基线资料匹配的20名健康志愿者为对照组进行对比分析。结果肺动脉高压组的P-VO2、无氧阈( AT)、摄氧效率斜率(OUES)和摄氧效率平台(OUEP)均显著低于对照组[(841±257)比(1682±284)ml/min、(661±171)比(1041±243)ml/min、1.1±0.4比2.3±0.4和25.8±5.2比35.5±4.0],各参数占预计值的百分比(%预计值)也均显著低于对照组(均P<0.001)。而最低通气效率[分钟通气量( VE)与CO2排出量(VCO2)比值的最低值(L-VE/VCO2)]和VE/VCO2斜率显著高于对照组(50.5±15.9比30.5±3.0和57.2±23.2比25.6±2.8,均P<0.001)。 Pearson相关分析显示,除VE/VCO2斜率%预计值外,AT%预计值、L-VE/VCO2%预计值、OUES%预计值及OUEP%预计值均与P-VO2%预计值相关(均P<0.001)。多重线性回归发现,只有AT%预计值与OUES%预计值是P-VO2%预计值的独立预测指标(β=0.394和0.384,均P<0.001),且OUES%预计值对运动耐力的影响更大(校正β=0.674)。当AT%预计值以58.0%为分界点、OUES%预计值以65.0%为分界点时,诊断肺动脉高压患者运动耐力严重降低的敏感度和特异度分别为92.3%、96.2%和81.2%、75.5%。结论肺动脉高压患者的运动耐力降低,次极量运动参数OUES%预计值及AT%预计值可作为评估运动耐力的独立预测指标,且OUES%预计值预估价值可能更高。
目的:探討肺動脈高壓患者次極量運動參數與峰值攝氧量( P-VO2)的相關性。方法迴顧性分析2010年10月至2013年10月在同濟大學附屬上海市肺科醫院住院治療的106例肺動脈高壓患者(肺動脈高壓組)的臨床資料,包括肺功能、氨基末耑腦利鈉肽前體( NT-proBNP )測定、6 min步行試驗、右心導管檢查及心肺運動試驗的結果資料,併以同期無吸煙史、無心肺疾病及基線資料匹配的20名健康誌願者為對照組進行對比分析。結果肺動脈高壓組的P-VO2、無氧閾( AT)、攝氧效率斜率(OUES)和攝氧效率平檯(OUEP)均顯著低于對照組[(841±257)比(1682±284)ml/min、(661±171)比(1041±243)ml/min、1.1±0.4比2.3±0.4和25.8±5.2比35.5±4.0],各參數佔預計值的百分比(%預計值)也均顯著低于對照組(均P<0.001)。而最低通氣效率[分鐘通氣量( VE)與CO2排齣量(VCO2)比值的最低值(L-VE/VCO2)]和VE/VCO2斜率顯著高于對照組(50.5±15.9比30.5±3.0和57.2±23.2比25.6±2.8,均P<0.001)。 Pearson相關分析顯示,除VE/VCO2斜率%預計值外,AT%預計值、L-VE/VCO2%預計值、OUES%預計值及OUEP%預計值均與P-VO2%預計值相關(均P<0.001)。多重線性迴歸髮現,隻有AT%預計值與OUES%預計值是P-VO2%預計值的獨立預測指標(β=0.394和0.384,均P<0.001),且OUES%預計值對運動耐力的影響更大(校正β=0.674)。噹AT%預計值以58.0%為分界點、OUES%預計值以65.0%為分界點時,診斷肺動脈高壓患者運動耐力嚴重降低的敏感度和特異度分彆為92.3%、96.2%和81.2%、75.5%。結論肺動脈高壓患者的運動耐力降低,次極量運動參數OUES%預計值及AT%預計值可作為評估運動耐力的獨立預測指標,且OUES%預計值預估價值可能更高。
목적:탐토폐동맥고압환자차겁량운동삼수여봉치섭양량( P-VO2)적상관성。방법회고성분석2010년10월지2013년10월재동제대학부속상해시폐과의원주원치료적106례폐동맥고압환자(폐동맥고압조)적림상자료,포괄폐공능、안기말단뇌리납태전체( NT-proBNP )측정、6 min보행시험、우심도관검사급심폐운동시험적결과자료,병이동기무흡연사、무심폐질병급기선자료필배적20명건강지원자위대조조진행대비분석。결과폐동맥고압조적P-VO2、무양역( AT)、섭양효솔사솔(OUES)화섭양효솔평태(OUEP)균현저저우대조조[(841±257)비(1682±284)ml/min、(661±171)비(1041±243)ml/min、1.1±0.4비2.3±0.4화25.8±5.2비35.5±4.0],각삼수점예계치적백분비(%예계치)야균현저저우대조조(균P<0.001)。이최저통기효솔[분종통기량( VE)여CO2배출량(VCO2)비치적최저치(L-VE/VCO2)]화VE/VCO2사솔현저고우대조조(50.5±15.9비30.5±3.0화57.2±23.2비25.6±2.8,균P<0.001)。 Pearson상관분석현시,제VE/VCO2사솔%예계치외,AT%예계치、L-VE/VCO2%예계치、OUES%예계치급OUEP%예계치균여P-VO2%예계치상관(균P<0.001)。다중선성회귀발현,지유AT%예계치여OUES%예계치시P-VO2%예계치적독립예측지표(β=0.394화0.384,균P<0.001),차OUES%예계치대운동내력적영향경대(교정β=0.674)。당AT%예계치이58.0%위분계점、OUES%예계치이65.0%위분계점시,진단폐동맥고압환자운동내력엄중강저적민감도화특이도분별위92.3%、96.2%화81.2%、75.5%。결론폐동맥고압환자적운동내력강저,차겁량운동삼수OUES%예계치급AT%예계치가작위평고운동내력적독립예측지표,차OUES%예계치예고개치가능경고。
Objective To explore the correlation between submaximal exercise measurements and peak oxygen uptake in patients with pulmonary arterial hypertension ( PAH) .Methods The clinical data were retrospectively analyzed for 106 patients with PAH from Affiliated Shanghai Pulmonary Hospital , Tongji University from October 2010 to October 2013.The examinations included routine pulmonary function test , N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk test, right heart catheterization and cardiopulmonary exercise testing.And within the same period , matched 20 healthy subjects without smoking and cardiopulmonary diseases were selected as control group .Results Peak oxygen uptake ( P-VO2 ) , anaerobic threshold (AT), oxygen uptake efficiency slope ( OUES) and oxygen uptake efficiency plateau (OUEP) were significantly lower in patients with PAH than control group ((841 ±257) vs (1 682 ±284) ml/min, (661 ±171) vs (1 041 ±243) ml/min, 1.1 ±0.4 vs 2.3 ±0.4, 25.8 ±5.2 vs 35.5 ±4.0,respectively) (all P<0.001).And the predicted parametric values (%pred) were also lower in PAH group than control group (all P <0.001).While the lowest ventilation (VE)/CO2 output (VCO2) (L-VE/VCO2 ) and VE/VCO2 slope were significantly higher in PAH group than control group ( 50.5 ±15.9 vs 30.5 ±3.0 and 57.2 ±23.2 vs 25.6 ±2.8, both P<0.001).Pearson correlation analysis showed , except for VE/VCO2 slope%pred, AT%pred, L-VE/VCO2%pred, OUES%pred and OUEP%pred were correlated with P-VO2(all P<0.001).According to multiple linear regression analysis , only AT%pred and OUES%pred were the independent predictors of P-VO2 (β=0.394, 0.384, both P <0.001 ) and OUES%pred might be better than AT%pred ( the adjusted β=0.674 ).When AT%pred<58.0% or OUES%pred<65.0%, exercise capacity in PAH declined obviously with the sensitivity was 92.3% and 96.2% and the specificity 81.2% and 75.5% respectively .Conclusions Exercise capacity in patients with PAH is significantly lower than healthy subjects.OUES%pred and AT%pred may be used as an independent predictor of exercise capacity.And OUES%pred may be more powerful .