特发性肺动脉高压患者心肺运动试验临床观察  

Clinical observation of cardiopuimonary exercise test in patients with idiopathic pulmonary arterial hypertension

作　　者：罗勤[1] 柳志红[1] 马秀平[1] 赵智慧[1] 顾晴[1] 熊长明 倪新海[1] 何建国[1] 赵青[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院国家心血管病中心心血管疾病国家重点实验室,100037

出　　处：《中华医学杂志》2013年第22期1683-1686,共4页National Medical Journal of China

摘　　要：目的观察特发性肺动脉高压（IPAH）患者心肺运动试验的临床结果。方法连续人选阜外心血管病医院2010年11月至2012年9月确诊为IPAH的76例患者（IPAH组）和年龄、性别相匹配的24名健康成人（对照组），进行心肺运动试验，并测定IPAH组纽约心脏病协会（NYHA）心功能分级、6min步行距离（6MWD）、氨基末端脑利钠肽前体（NT—proBNP）及血流动力学参数。结果IPAH组男21例，女55例；年龄（31．5±10．6）岁，对照组男8名，女16名；年龄（35．5±6．4）岁。IPAH组峰值氧耗量、无氧阈和峰值氧脉搏分别为（12．7±3．3）、（9．8±2．5）ml·min^-1·kg^-1和（5．3±1．6）ml／次，明显低于对照组的（25．6±5．8）、（16．74-3．9）ml·min^-1·kg^-1和（9．9±2．5）ml／次（均P=0．000）；而通气效率（分钟通气量与二氧化碳排出量比值的斜率）（42．6±2．0）明显高于对照组（25．5±3．5）（P=0．000）。相关性分析显示峰值氧耗量、无氧阈与NYHA心功能分级、6MWD、NT—proBNP呈显著相关，峰值氧脉搏和通气效率与全肺血管阻力显著相关。偏相关分析显示在控制年龄、性别、体重后峰值氧耗量、无氧阈与NYHA心功能分级、6MWD、NT—proBNP仍相关。结论IPAH患者峰值氧耗量和无氧阈明显下降，心肺运动试验作为一种无创性检查能安全评估IPAH患者功能状态。Objective To explore the exercise characteristics of patients with idiopathic pulmonary arterial hypertension （IPAH）. Methods From November 2010 to September 2012 , 76 consecutive IPAH patients and 24 healthy c.ontrols from Fuwai Cardiovascular Hospital were enrolled to undergo cardiopulmonary exercise testing. The exercise parameters were compared. Correlations among peak oxygen consumption, anaerobic threshold, peak oxygen pulse, New York Heart Association （NYHA） class, N- terminal pro-brain natriuretic peptide （NT-proBNP）, 6-minute walking distance （6 MWD ） and cardiac index are analyzed in iPAH. Results There were 21 males and 55 females in IPAH and g males and 16 females in controls. Their mean ages were （31.5 ±10. 6） and （35.5 ＋ 6.4） years respectively. Significant differences （P =0. 000） existed between two groups in peak oxygen consumption （（ 12. 7 ±3.3） vs （25.6 ± 5.8） ml·min^-1·kg^-1）, anaerobic threshold （（9.8±2.5） vs （16.7±3.9） ml·min^-1·kg^-1）, peak oxygen pulse （ （5.3 ±1.6） vs （9.9 ±2.5 ） mi/bpm） and ventilator efficiency （sh）pe of minute ventilation in relation to CO2 produced） （（42. 6 ±2. 0） vs （25.5 ±3.5））. In IPAH, peak oxygen consumption was significantly correlated with NYHA class （r = -0. 509, P =0. 000）, 6 MWD （r =0. 443, P =0. 002） and NT-proBNP levels （ r = - 0. 423, P = 0. 011 ）. And anaerobic threshold was significantly correlated with NYHAclass （r= -0.362, P=0.002）, 6MWD （r=0.343, P=0.004） and NT-proBNP levels （r= -0. 275, P ： O. 017）. Peak oxygen pulse and ventilator efficiency were both correlated well with total pulmonary vascular resistance. Partial correlation analysis demonstrated that there were significant correlations among peak oxygen cnnsunlption, anaerobic threshold, NYHA class, NT-proBNP levels and 6MWI） after adjusting for age, gender and weight. Conclusions Peak oxygen consumption and anaerobic threshold decrease ventilator efficiency in IPAH patien

关 键 词：高血压 肺性 运动试验 氧耗量 无氧阈 

分 类 号：R544[医药卫生—心血管疾病]