心肺运动试验用于冠心病诊断价值的临床研究  

Clinical study on the diagnostic value of cardiopulmonary exercise test for coronary atherosclerotic heart disease

作　　者：朱珊雨 王曦[1] 孙兴国 ZHU Shan-yu;WANG Xi;SUN Xing-guo(The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016;Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100000,China)

机构地区：[1]重庆医科大学附属第一医院,重庆400016 [2]中国医学科学院阜外医院国家心血管病中心北京协和医学院心血管疾病国家重点实验室国家心血管疾病临床医学研究中心,北京100037

出　　处：《中国应用生理学杂志》2021年第1期72-78,共7页Chinese Journal of Applied Physiology

基　　金：国家高技术研究发展计划(863计划)课题资助项目(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国康复医疗机构联合重大项目基金(20160102);中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02);首都临床特色应用研究与成果推广(Z161100000516127);北京康复医院2019-2021科技发展专项(2019-003);北京协和医学院教学改革项目(2018E-JG07);北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660);重庆市卫计委医学科研计划项目(2017MSXM090);重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)。

摘　　要：目的:评估心肺运动试验(CPET)相关指标对于冠心病的诊断价值。方法:选择156例疑诊为冠心病的患者(病情相对稳定,年龄在18~80岁)行CPET、运动负荷心电图及冠状动脉造影,以冠状动脉造影结果为标准,分析CPET相关指标(峰值摄氧量%预计值Peak VO_(2)%pred、峰值氧脉搏%预计值Peak O_(2) pulse%pred、摄氧量对应功率的做功效率(ΔVO_(2)/ΔWR)诊断冠心病的敏感度、特异度及其诊断价值。结果:Peak VO_(2)%pred的最佳截断点是≤69%pred,其诊断冠心病的敏感度为55.1%,特异度为77.0%,AUC为0.698。Peak O_(2) pulse%pred最佳截断点诊断冠心病的敏感度为50.7%,特异度为72.4%,AUC为0.58。ΔVO_(2)/ΔWR最佳截断点处其诊断冠心病的敏感度为44.9%,特异度为87.4%,AUC为0.647。Peak VO_(2)%pred及ΔVO_(2)/ΔWR敏感度远高于负荷心电图,差异有统计学意义(P<0.01)。结论:CPET部分指标诊断冠心病的敏感度优于运动负荷心电图,最佳截断点处特异度及诊断价值均较高,而且CPET本身也包括连续动态全程心电图分析,不建议各自分割使用,主张所有指标整体整合分析使用。CPET相关指标对冠心病诊断有预测价值,可以早期、较准确的诊断冠心病。Objective:To evaluate the value of cardiopulmonary exercise testing in diagnosing coronary atherosclerotic heart disease(CHD).Methods:A total of 156 patients with suspected CHD(The patient's condition is relatively stable,aged 18 to 80 years)were performed for cardiopulmonary exercise testing,ECG exercise test and coronary angiography.Based on the results of coronary angiography,the sensitivity,specificity and diagnostic value of relevant indicators of cardiopulmonary exercise testing(CPET)parameters(Peak VO_(2)%pred、Peak O_(2) pulse%pred、ΔVO_(2)/ΔWR)in diagnosing CHD were analyzed by statistical methods based on the results of coronary angiography.Results:Useing the best cut-off point of Peak VO_(2)≤69%pred for detecting CHD,the sensitivity was 55.1%,the specificity was 77.0%,and the AUC was 0.698.The sensitivity,specificity and AUC of peak O_(2) pulse%pred were 50.7%,72.4%and 0.58 respectively.ΔVO_(2)/ΔWR sensitivity in diagnosing CHD was 44.9%,specificity was 87.4%,AUC was 0.647.The sensitivity of peak O_(2) pulse%pred andΔVO_(2)/ΔWR were much higher than the ECG exercise test,the difference was statistically significant(P<0.01).Conclusion:The sensitivity of some indexes of CPET in diagnosing CHD was better than ECG exercise test,the specificity and diagnostic value of the optimal cut-off point are high.CPET has predictive value for the diagnosis of CHD,it can diagnose CHD early and accurately.

关 键 词：心肺运动试验 冠心病 峰值摄氧量 峰值氧脉搏 摄氧量做功效率 运动心电图 

分 类 号：R541[医药卫生—心血管疾病]