CAJ | 학술논문

目的探讨心肺运动试验(CPET)比较3种肺动脉高压(PAH)患者心肺功能状态的价值.方法入选2012年12月至2013年5月入住阜外心血管病医院肺血管病诊治中心确诊的特发性PAH(特发组)、先天性心脏病性PAH(先心组)和结缔组织病相关性PAH(免疫组),均进行CPET,同时收集3组的一般资料、常规检查、氨基末端B型脑钠肽原(NT-proBNP)及6 min步行距离(6MWD)等结果并进行比较分析.结果共入选特发组32例、先心组38例、免疫组25例.特发组、先心组、免疫组峰值氧耗量与体重的比值(VO2 max/kg)分别为(12.3±2.3)、(14.9±4.0)、(11.1±2.5)ml·min-1·kg-1,3组间差异有统计学意义(P＜0.001),其中先心组显著高于其他两组(P=0.003,P＜0.001);峰值氧脉搏(VO2与心率比值的峰值)分别为(5.8±1.4)、(6.4±1.8)、(5.3±1.7)ml·次-1·min-,3组间差异亦有统计学意义(P =0.034),其中先心组显著高于免疫组(P=0.012);峰值心率分别为(136.1±21.4)、(140.8±19.9)、(124.5 ±21.6)次/min,3组间差异有统计学意义(P =0.011),其中免疫组最低且显著低于先心组(P =0.009).免疫组6MWD均显著低于特发组、先心组(P =0.006、0.010);免疫组Nt-proBNP显著高于先心组(P =0.012).VO2 max/kg与峰值氧脉搏、峰值心率、峰值收缩压、6MWD、Nt-proBNP、左心室舒张末内径、右心室舒张末内径均显著相关(r=0.477、0.518、0.387、0.465、-0.350、0.349、-0.259).结论 CPET可以客观、定量地评价PAH的心肺功能状态和运动耐量.
목적 탐토심폐운동시험(CPET)비교3충폐동맥고압(PAH)환자심폐공능상태적개치.방법 입선2012년12월지2013년5월입주부외심혈관병의원폐혈관병진치중심학진적특발성PAH(특발조)、선천성심장병성PAH(선심조)화결체조직병상관성PAH(면역조),균진행CPET,동시수집3조적일반자료、상규검사、안기말단B형뇌납태원(NT-proBNP)급6 min보행거리(6MWD)등결과병진행비교분석.결과 공입선특발조32례、선심조38례、면역조25례.특발조、선심조、면역조봉치양모량여체중적비치(VO2 max/kg)분별위(12.3±2.3)、(14.9±4.0)、(11.1±2.5)ml·min-1·kg-1,3조간차이유통계학의의(P＜0.001),기중선심조현저고우기타량조(P=0.003,P＜0.001);봉치양맥박(VO2여심솔비치적봉치)분별위(5.8±1.4)、(6.4±1.8)、(5.3±1.7)ml·차-1·min-,3조간차이역유통계학의의(P =0.034),기중선심조현저고우면역조(P=0.012);봉치심솔분별위(136.1±21.4)、(140.8±19.9)、(124.5 ±21.6)차/min,3조간차이유통계학의의(P =0.011),기중면역조최저차현저저우선심조(P =0.009).면역조6MWD균현저저우특발조、선심조(P =0.006、0.010);면역조Nt-proBNP현저고우선심조(P =0.012).VO2 max/kg여봉치양맥박、봉치심솔、봉치수축압、6MWD、Nt-proBNP、좌심실서장말내경、우심실서장말내경균현저상관(r=0.477、0.518、0.387、0.465、-0.350、0.349、-0.259).결론 CPET가이객관、정량지평개PAH적심폐공능상태화운동내량.
Objective To assess the exercise capacity of three kinds of pulmonary artery hypertension using cardiopulmonary exercise testing (CPET).Methods In the Center for Pulmonary Vascular Disease Diagnosis and Treatment of Fuwai Hospital, idiopathic pulmonary artery hypertension (IPAH), congenital heart disease associated pulmonary artery hypertension (CHD-PAH), connective tissue disease associated pulmonary artery hypertension (CTD-PAH) were enrolled into this study from December 2012 to May 2013.CPET was performed in all patients, and clinical features, routine tests results, N-terminal B-type natriuretic peptide (NT-proBNP), Six-minutes-walk distance (6MWD) were all collected.Results Thirty-two patients with IPAH, 38 patients with CHD-PAH, 25 patients with CTD-PAH were enrolled.For IPAH, CHD-PAH, and CTD-PAH patients, the peak oxygen uptake via body weight (VO2max/kg) was (12.3±2.3), (14.9 ±4.0), and (11.1 ±2.5) ml · min-1 · kg-1, respectively.The peak VO2/kg was significantly different within these three groups (P ＜ 0.001), and was significantly higher in CHD-PAH patients compared with the other two groups (P =0.003, P ＜ 0.001).The peak VO2/heartrate (HR) was (5.8±1.4), (6.4±1.8), (5.3±1.7) ml · beat-1 · min-1 in the above three groups and was significantly different within these three groups (P =0.034).The peak VO2/HR was significantly increased in CHD-PAH patients than CTD-PAD patients (P =0.012).The peak HR was (136.1 ±21.4), (140.8 ± 19.9), (124.5 ± 21.6) beat/min respectively and was significantly lower in CTD-PAD patients than CHD-PAH patients (P =0.009).The 6MWD was significantly decreased in CTDPAD patients compared with CHD-PAH and IPAH patients (P =0.006, 0.010).Nt-proBNP was significantly decreased in CTD-PAD patients compared with CHD-PAH patients (P =0.012).In Pearson and partial correlation analysis, the peak VO2/kg was significantly correlated with peak VO2/HR, peak HR, 6MWD, Nt-proBNP, left ventricular end-diastolic diameter, right ventricular end-diastolic diameter (r =0.477, 0.518, 0.387, 0.465,-0.350, 0.349,-0.259).Conclusion CPET parameters can objectively evaluate exercise capacity and cardiopulmonary function of the patients with pulmonary hypertension.