心肺运动试验评价特发性肺动脉高压钙离子拮抗剂疗效的研究  

Effect of calcium channel blockers in idiopathic pulmonary arterial hypertension evaluated by cardiopulmonary exercise testing

作　　者：唐毅 张敏[2] 刘君宇 柳志红[3] 钟常青[1] 张良[1] 何晋[1] 唐铭翔[1] 傅庆华[1] 阳军[1] 潘宏伟[1] 张翼[1] 郑昭芬[1] 彭建强[1] TANG Yi;ZHANG Min;LIU Jun-yu;LIU Zhi-hong;ZHONG Chang-qing;ZHANG Liang;HE Jin;TANG Ming-xiang;FU Qing-hua;YANG Jun;PAN Hong-wei;ZHANG Yi;ZHENG Zhao-fen;PENG Jian-qiang(Department of Cardiology,Hunan Provincial People's Hospital,The first Affiliated Hospital of Hunan Normal University,the Clinical Medical Research Center of Heart Failure of Hunan Province,Changsha 410005,China)

机构地区：[1]湖南省人民医院湖南师范大学附属第一医院湖南省心力衰竭临床医学研究中心心血管内科,湖南长沙410005 [2]湖南师范大学附属第一医院湖南省人民医院心血管内科,湖南长沙410005 [3]北京协和医学院中国医学科学院阜外医院国家心血病中心肺血管病中心,北京100037

出　　处：《中国实用内科杂志》2021年第9期794-798,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金青年基金(81800056);湖南省社会发展领域重点研发项目(2019SK2021);湖南省临床医疗技术创新引导项目(2020SK50922)。

摘　　要：目的探讨心肺运动试验评价急性血管反应试验阳性特发性肺动脉高压(VR-IPAH)钙离子拮抗剂治疗效果。方法前瞻性入组2012年1月至2015年11月中国医学科学院阜外医院新诊断的VR-IPAH患者25例以及年龄、性别、肺血管阻力相匹配的急性血管反应试验阴性特发性肺动脉高压(VNR-IPAH)患者28例。心肺运动试验评估钙离子拮抗剂或西地那非治疗(3.5±0.8)个月前后两组患者心肺功能的变化情况。结果 VR-IPAH组在无氧阈和峰值的通气效率优于VNR-IPAH组(表现为分钟通气量与二氧化碳排出量比值更低,呼气末二氧化碳分压更高)。VR-IPAH组患者在接受钙离子拮抗剂治疗后,峰值耗氧量[(13.9±2.9)mL/(kg·min)对(16.4±4.1)mL/(kg·min),P=0.001],峰值氧脉搏[每搏(5.5±0.8)mL/min对(6.9±1.3)mL/min,P=0.001]、无氧阈时分钟通气量与二氧化碳排出量比值(34.2±5.0对31.6±3.1,P=0.02),无氧阈时呼气末二氧化碳分压[(33.1±4.0)mmHg对(35.3±3.2)mmHg,P=0.02](1 mmHg=0.133 k Pa)得到改善,同时心功能、6 min步行距离、氨基末端B型利钠肽前体(NT-proBNP)、三尖瓣反流压差也得到改善。结论 VR-IPAH患者通气效率优于VNR-IPAH患者。钙离子拮抗剂治疗能够改善VR-IPAH患者用氧能力及通气效率。Objective To evaluate the effect of calcium channel blockers in idiopathic pulmonary arterial hypertensionresponding to acute pulmonary vasoreactivity testing using cardiopulmonary exercise testing. Methods 25 patients withnewly diagnosed idiopathic pulmonary arterial hypertension responding to acute pulmonary vasoreactivity testing(VR-IPAH)from January 2012 to November 2015 in Fuwai Hospital,Chinese Academy of Medical Sciences were prospectivelyenrolled,and 28 age-,sex-and pulmonary vascular resistance-matched newly diagnosed patients with vasodilator-nonresponsive idiopathic pulmonary arterial hypertension(VNR-IPAH)were enrolled. CPET was performed before and after(3.5±0.8)months of calcium channel blockers or Sildenafil therapy. Results Ventilatory efficiency at anaerobic thresholdand peak was significantly higher(lower in VE/VCO_(2) and higher in PETCO_(2))in VR-IPAH group than that in VNR-IPAH group. Peak VO_(2)[(13.9 ± 2.9)m L/kg · min vs.(16.4 ± 4.1)m L/kg · min,P=0.001],peak O_(2) pulse[(5.5±0.8)m L/min·beat vs.(6.9±1.3)m L/min·beat,P=0.001],VE/VCO_(2) at anaerobicthreshold(34.2±5.0 vs.31.6±3.1,P=0.02)and PETCO_(2) at anaerobic threshold[(33.1±4.0)mm Hg vs.(35.3 ± 3.2) mm Hg, P=0.02] were significantly improved after calcium channel blockers therapy,along with improvement of cardiac function,6-minutes walking distance,NT-pro BNP and tricuspid regurgitation pressure gradient. Conclusions Ventilatory efficiency in patients with VR-IPAH is better than that in patients with VNR-IPAH. Calcium channel blickers can improve aerobic capacity and ventilatory efficiency during exercise in patients with VR-IPAH.

关 键 词：特发性肺动脉高压 心肺运动试验 急性血管反应试验 钙离子拮抗剂 

分 类 号：R544[医药卫生—心血管疾病]