特发性肺纤维化患者的通气有效性及运动耐力研究
특발성폐섬유화환자적통기유효성급운동내력연구
Ventilatory efficiency and exercise capacity during exercise in patients with idiopathic pulmonary fibrosis
  • 万方数据
    中华全科医师杂志 중화전과의사잡지
    CHINESE JOURNAL OF GENERAL PRACTITIONERS
    2014年 1期 41-46 ,共6页

    黄丹丹%刘锦铭%杨文兰%孙兴国%陈淑娟%吴常伟%刘海舰

    황단단%류금명%양문란%손흥국%진숙연%오상위%류해함

    特发性肺纤维化%运动试验%呼吸功能试验%血气分析 特髮性肺纖維化%運動試驗%呼吸功能試驗%血氣分析
    특발성폐섬유화%운동시험%호흡공능시험%혈기분석
    Pulmonary fibrosis%Exercise test%Respiratory function tests%Blood gas analysis
    目的 通过心肺运动试验研究特发性肺纤维化(IPF)对患者通气有效性及其运动耐力的影响.方法 对2012年4月至2013年4月确诊为IPF的28例患者(IPF组)和28名年龄、性别匹配的健康志愿者(正常对照组)进行常规肺功能检测、动脉血气分析和心肺运动试验,并测定相关参数.结果 两组间年龄[(58±10)比(59 ±5)岁]、性别、BMI[(23.8 ±2.7)比(25.0 ±2.8)kg/m2]差异均无统计学意义(均P ＞0.05).IPF组用力肺活量占预计值百分比、第1秒用力呼气容积占预计值百分比、最大分钟通气量占预计值百分比、肺总量占预计值百分比、残气量占预计值百分比、肺CO弥散量占预计值百分比均显著低于正常对照组,分别为(74.8±14.6)％比(101.8±10.8)％、(73.8±14.6)％比(97.0±10.1)％、(77.5±14.9)％比(95.4 ±24.5)％、(75.6±12.4)％比(99.8±5.4)％、(80.7±15.4)％比(95.8±11.3)％、(66.3±13.7)％比(103.2±17.3)％,均P＜ 0.01.IPF组PaO2、SaO2低于正常对照组,分别为(72.7 ±7.3)mmHg(1 mmHg =0.133 kPa)比(92.6±3.8)mmHg、(94.3±2.1)％比(98.3±0.7)％,均P＜0.01,而IPF组的肺泡动脉氧分压差则明显高于正常对照组[(33.3±5.7)mmHg比(17.8±1.9) mmHg,P＜0.01].心肺运动试验结果显示,IPF组每分钟通气量与CO2排出量(VE/VCO2)的线性斜率、VE/VCO2最小值均显著高于正常对照组,分别为37.4±5.3比25.7±2.5、39.2±6.7比30.6±2.7,均P＜0.01;IPF组4个时期的VE/VCO2和死腔气量与潮气量比均显著高于正常对照组(均P ＜0.01);IPF组峰值运动负荷占预计值百分比、峰值摄氧量占预计值百分比显著低于正常对照组,分别为(70.4±29.9)％比(104.8±29.7)％、(68.7±29.8)％比(98.7±36.4)％,均P＜0.01.IPF患者无氧阈时的每分钟通气量与C02排出量比值(VF/VCO2@AT)、VE/VCO2线性斜率及VE//VCO2最小值与静息时的肺CO弥散量占预计值百分比呈负相关(分别为r=-0.589,P＜0.01;r=-0.481,P＜0.05;r=-0.527,P＜0.05),其峰值摄氧量占预计值百分比与VE/VCO2@AT、VE/VCO2线性斜率、VE/VCO2最小值呈负相关(分别为r=-0.548,P＜0.05;r=-0.539,P＜0.05;r=-0.564,P＜0.05).结论 特发性肺纤维化使患者的通气有效性明显降低,严重影响患者的运动耐力.
    목적 통과심폐운동시험연구특발성폐섬유화(IPF)대환자통기유효성급기운동내력적영향.방법 대2012년4월지2013년4월학진위IPF적28례환자(IPF조)화28명년령、성별필배적건강지원자(정상대조조)진행상규폐공능검측、동맥혈기분석화심폐운동시험,병측정상관삼수.결과 량조간년령[(58±10)비(59 ±5)세]、성별、BMI[(23.8 ±2.7)비(25.0 ±2.8)kg/m2]차이균무통계학의의(균P ＞0.05).IPF조용력폐활량점예계치백분비、제1초용력호기용적점예계치백분비、최대분종통기량점예계치백분비、폐총량점예계치백분비、잔기량점예계치백분비、폐CO미산량점예계치백분비균현저저우정상대조조,분별위(74.8±14.6)％비(101.8±10.8)％、(73.8±14.6)％비(97.0±10.1)％、(77.5±14.9)％비(95.4 ±24.5)％、(75.6±12.4)％비(99.8±5.4)％、(80.7±15.4)％비(95.8±11.3)％、(66.3±13.7)％비(103.2±17.3)％,균P＜ 0.01.IPF조PaO2、SaO2저우정상대조조,분별위(72.7 ±7.3)mmHg(1 mmHg =0.133 kPa)비(92.6±3.8)mmHg、(94.3±2.1)％비(98.3±0.7)％,균P＜0.01,이IPF조적폐포동맥양분압차칙명현고우정상대조조[(33.3±5.7)mmHg비(17.8±1.9) mmHg,P＜0.01].심폐운동시험결과현시,IPF조매분종통기량여CO2배출량(VE/VCO2)적선성사솔、VE/VCO2최소치균현저고우정상대조조,분별위37.4±5.3비25.7±2.5、39.2±6.7비30.6±2.7,균P＜0.01;IPF조4개시기적VE/VCO2화사강기량여조기량비균현저고우정상대조조(균P ＜0.01);IPF조봉치운동부하점예계치백분비、봉치섭양량점예계치백분비현저저우정상대조조,분별위(70.4±29.9)％비(104.8±29.7)％、(68.7±29.8)％비(98.7±36.4)％,균P＜0.01.IPF환자무양역시적매분종통기량여C02배출량비치(VF/VCO2@AT)、VE/VCO2선성사솔급VE//VCO2최소치여정식시적폐CO미산량점예계치백분비정부상관(분별위r=-0.589,P＜0.01;r=-0.481,P＜0.05;r=-0.527,P＜0.05),기봉치섭양량점예계치백분비여VE/VCO2@AT、VE/VCO2선성사솔、VE/VCO2최소치정부상관(분별위r=-0.548,P＜0.05;r=-0.539,P＜0.05;r=-0.564,P＜0.05).결론 특발성폐섬유화사환자적통기유효성명현강저,엄중영향환자적운동내력.
    Objective To explore the characteristics of ventilatory efficiency and exercise capacity during cardiopulmonary exercise testing in patients with idiopathic pulmonary fibrosis (IPF).Methods Pulmonary function test,arterial blood gas analysis and cardiopulmonary exercise testing were performed in 28 IPF patients (IPF group) from April 2012 to April 2013 and 28 healthy volunteers (control group).And the relevant parameters were measured and compared.Results No significant differences existed in age [(57.8 ±9.8) vs.(59.2 ±5.5) years],gender or body mass index (BMI) [(23.8 ±2.7) vs.(25.0 ± 2.8) kg/m2,P ＞ 0.05].The paramneters of pulmonary function test,such as forced vital capacity ％ predicted (74.8 ± 14.6 vs.101.8 ± 10.8),forced expiratory volume in 1 second ％ predicted (73.8 ± 14.6 vs.97.0 ± 10.1),maximum voluntary ventilation ％ predicted (77.5 ± 14.9 vs.95.4 ±24.5),total lung capacity ％ predicted (75.6 ± 12.4 vs.99.8 ± 5.4),residual volume ％ predicted (80.7 ± 15.4 vs.95.8 ± 11.3),diffusing capacity of lung for carbon monoxide ％ predicted (66.2 ± 13.7 vs.103.2 ± 17.3) in the IPF group,were significantly lower than those of the control group (P ＜ 0.01).The parameters of arterial blood gas analysis,such as PaO2 [(72.7 ± 7.3) vs.(92.6 ± 3.8) mmHg] and SaO2 (94.3 ± 2.1 vs.98.3 ± 0.7),were lower than those of the control group (P ＜ 0.01).Thus P(A-a) O2 in the IPF group was higher than that in the control group (33.3 ± 5.7 vs.17.8 ± 1.9,P ＜0.01).These results strongly suggested that IPF group had restrictive ventilatory dysfunction and impaired gas exchange.The IPF patients had higher VE/VCO2-slope (37.4 ± 5.3 vs.25.7 ± 2.5,P ＜ 0.01) and lowest VE/VCO2 (39.2 ±6.7 vs.30.6 ± 2.7,P ＜ 0.01) than the controls; VE/VCO2 and VD/VT during every period were significantly higher in the IPF group than those in the control group (P ＜ 0.01) ; during peak exercise,peakLoad％pred (70.4 ±±29.9 vs.104.8 ±29.7,P ＜0.01) and peakVO2％pred (68.7 ±29.8 vs.98.7 ±36.4,P =0.001) were significantly lower in the IPF group than those in the control group.In the IPF group,VE/VCO2@AT,VE/VCO2-slope and lowest VE/VCO2 had a negative correlation with DLCO％pred (r=-0.589,P ＜0.01; r=-0.481,P＜0.05; r=-0.527,P＜0.05).In the IPF group,VE/VCO2@AT,VE/VCO2-slope and lowest VE/VCO2 had a negative correlation with peakVO2％ pred (r =-0.548,P ＜ 0.05 ; r =-0.539,P ＜ 0.05 ; r =-0.564,P ＜ 0.05).So the exercise tolerance and ventilation efficiency of the IPF group decreased significantly.Conclusion Cardiopulmonary exercise testing reveals that the ventilation efficiency of IPF patients decreases significantly so as to seriously affect their exercise tolerance
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