心肺运动试验相关指标对不同肾功能状态冠心病患者预后预测价值  

Prognostic value of cardiopulmonary exercise testing in patients with coronary artery disease with different renal function

作　　者：韩帆 李宇珊 任强 王艳霞 张伊 王圣熠 梁延春 张剑 张权宇 HAN Fan;LI Yu-shan;REN Qiang;WANG Yan-xia;ZHANG Yi;WANG Sheng-yi;LIANG Yan-chun;ZHANG Jian;ZHANG Quan-yu(Third Cadet Group,School of Basic Medicine,Air Force Medical University,Xi'an 710032,China;Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]空军军医大学基础医学院学员三大队,陕西西安710032 [2]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2024年第2期130-134,138,共6页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划项目(2022JH2/101500028)。

摘　　要：目的探讨心肺运动试验(CPET)相关指标对不同肾功能状态冠心病(CAD)患者预后的预测价值。方法选取北部战区总医院心血管内科自2016年2月至2021年12月收治且在出院前完成CPET的5087例CAD患者为研究对象。根据入院时估计肾小球滤过率(eGFR),将患者分为肾功能正常组(eGFR≥60 ml/min,n=4969)与肾功能异常组(eGFR<60 ml/min,n=118)。收集两组患者的人口学特点、既往病史、实验室检查结果、用药史及CPET结果等。记录两组患者主要不良心血管事件(MACE)的发生情况。采用多因素COX回归分析评估不同肾功能状态CAD患者心肺功能及与预后的相关性。结果匹配后,肾功能异常组患者的峰值心率、峰值摄氧量、峰值代谢当量均低于肾功能正常组,氧通气当量、心率储备均高于肾功能正常组,差异均有统计学意义(P<0.05)。两组患者匹配后的临床结局事件发生率比较,差异均无统计学意义(P>0.05)。多因素COX回归分析结果显示:在总体研究人群中,吸烟史、高血压分级、既往经皮冠状动脉介入术(PCI)、肌酸激酶同工酶、N端B型钠尿肽原、峰值摄氧量、氧通气当量均为MACE的影响因素(P<0.05);在肾功能正常患者中,吸烟史、高血压分级、既往PCI、肌酸激酶同工酶、峰值摄氧量、氧通气当量均为MACE的影响因素(P<0.05);在肾功能异常患者中,吸烟史、高血压分级、射血分数、峰值摄氧量均为MACE的影响因素(P<0.05)。结论对于肾功能正常的患者,峰值摄氧量和氧通气当量对CAD患者预后存在预测价值;对于肾功能异常的患者,峰值摄氧量对CAD患者预后存在预测价值。Objective To investigate the prognostic value of cardiopulmonary exercise testing(CPET)in patients with coronary artery disease(CAD)with different renal status.Methods 5087 CAD patients who completed CPET from February 2016 to December 2021 in the Department of Cardiology of General Hospital of Northern Theater Command were selected as the study objects.According to the estimated glomerular filtration rate(eGFR)at admission,patients were divided into normal renal function group(eGFR≥60 ml/min,n=4969)and abnormal renal function group(eGFR<60 ml/min,n=118).Demographic characteristics,past medical history,laboratory test results,medication history and CPET results of the two groups of patients were collected.Major adverse cardiovascular events(MACE)were recorded in both groups.Multivariate COX regression analysis was used to evaluate cardiopulmonary function and its correlation with prognosis in CAD patients with different renal status.Results After matching,the peak heart rate,peak oxygen uptake and peak metabolic equivalent of patients in the abnormal renal function group were lower than those in the normal renal function group,and the oxygen ventilation equivalent and heart rate reserve were higher than those in the normal renal function group,with statistical significance(P<0.05).After matching,there was no statistical significance in the incidence of clinical outcome events between the two groups(P>0.05).Multivariate COX regression analysis showed that smoking history,hypertension grade,previous percutaneous coronary intervention(PCI),creatine kinase isoenzyme,N-terminal pro-B-type natriuretic peptide,peak oxygen uptake and oxygen ventilation equivalent were all influencing factors of MACE in the overall study population(P<0.05).In the patients with normal renal function,smoking history,hypertension grade,previous PCI,creatine kinase isoenzyme,peak oxygen uptake and oxygen ventilation equivalent were the influencing factors of MACE(P<0.05).In the patients with renal dysfunction,smoking history,hypertension gr

关 键 词：冠心病 心肺运动试验 肾功能异常 估计肾小球滤过率 

分 类 号：R542.2[医药卫生—心血管疾病]