肺动脉高压患者右心室-肺动脉失耦联与心肺运动试验评估通气效率和运动耐力降低的关系  

Correlation between Ventilatory Efficiency and Reduced Exercise Endurance Evaluated by Right Ventricular Pulmonary Artery Coupling and Cardiopulmo⁃nary Exercise Testing in Patients with Pulmonary Arterial Hypertension

作　　者：段朦朦 刘琳[2] 王森[2] 蒋鹤 高民[2] 窦灵芝 李珊珊[2] 阮宏云 DUAN Mengmeng;LIN Liu;WANG Sen;JIANG He;GAO Min;DOU Zhiling;LI Shanshan;RUAN Hongyun(BengBu Medical University,Bengbu,Anhui 233030,China;Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China;Xuzhou Institute of Cardiovascular Disease,Xuzhou,Jiangsu 221009,China)

机构地区：[1]蚌埠医科大学,安徽蚌埠233030 [2]徐州市中心医院,江苏徐州22100 [3]徐州市心血管病研究所,江苏徐州221009

出　　处：《岭南心血管病杂志》2025年第1期63-68,共6页South China Journal of Cardiovascular Diseases

基　　金：徐州市卫生健康委医学科技创新项目(项目编号:XWKYHT20220155)。

摘　　要：目的观察肺动脉高压患者无创右心室-肺动脉耦联参数与心肺运动试验(cardiopulmonary exercise testing,CPET)评估的通气效率、运动耐力之间的相关性。方法选取50例经右心导管检查诊断明确为肺动脉高压的患者,分别进行经胸超声心动图、CPET、6 min步行距离(6-minute walking distance,6MWD)检查以及检测其N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)及右心功能分级(World Health Organization-function classification,WHO-FC)等指标。超声心动图参数主要包括三尖瓣环平面收缩期位移(tricuspid annular plane systolic excursion,TAPSE)、三尖瓣外侧瓣环收缩期峰值速度S′、肺动脉收缩压(systolic pulmonary arterial pressure,sPAP)等指标;无创右心室-肺动脉耦联以TAPSE/sPAP的比值表示。CPET参数包括通气效率(分钟通气量/二氧化碳产生量斜率,VE/VCO_(2)slope)和运动耐力(最大摄氧量peak VO_(2))等指标。结果在肺动脉高压患者中,TAPSE/sPAP与VE/VCO_(2)slope呈显著负相关(r=-0.440,P<0.005),而与peak VO_(2)呈显著正相关(r=0.537,P<0.001)。TAPSE/sPAP与6MWD呈显著正相关(r=0.572,P<0.001),而与NT-proBNP及WHO-FC显示出明显负相关性,分别为(r=-0.443,P=0.013)及(r=-0.440,P<0.005)。单独TAPSE值与VE/VCO_(2)slope有相关性,但与peak VO_(2)并无明显相关性。结论肺动脉高压患者右心室-肺动脉耦联与通气效率呈明显负相关,与运动耐力呈明显正相关性,提示随着肺动脉高压病情进展,肺通气效率下降,右心功能减低。Objectives To evaluate the correlation between ventilatory efficiency and reduced exercise endurance evaluated by cardiopulmonary exercise testing(CPET)and non-invasiveright ventricular pulmonary artery coupling parameters in patients with pulmonary arterial hypertension(PAH).Methods Fifty patients with PAH diagnosed by right heart catheterization(RHC)were selected.They were measured by transthoracic echocardiography,CPET,6-minute walking distance(6MWD),and their N-terminal pro-brain natriuretic peptide(NT-proBNP),right ventricular World Health Organization-function classification(WHO-FC)were tested.Echocardiographic parameters mainly include tricuspid annular plane systolic excursion(TAPSE),lateral tricuspid annular systolic peak velocity S′,systolic pulmonary arterial pressure(sPAP)and other indicators.Furthermore,the TAPSE/sPAP ratiorepresented a non-invasive measure of right ventricular pulmonary artery coupling.CPET parameters include ventilation efficiency(minute ventilation/carbon dioxide production slope,VE/VCO_(2)slope)and exercise endurance(peakVO_(2)).Results In patients with PAH,TAPSE/sPAP was negatively correlated with VE/VCO_(2)slope(r=-0.440,P<0.005),but positively correlated with peak VO_(2)(r=0.537,P<0.001).There was a significant positive correlation between TAPSE/sPAP and 6MWD(r=0.572,P<0.001),but a significant negative correlation with NT-proBNP and WHO-FC(r=-0.443,P=0.013;r=-0.440,P<0.005).There was a correlation between TAPSE value and VE/VCO_(2)slope,but no significant correlation between TAPSE with peak VO_(2).Conclusions In patients with PAH,TAPSE/sPAP is negatively correlated with ventilation efficiency and positively cor⁃related with exercise endurance,suggesting that with the progression of pulmonary hypertension,pulmonary ventilation efficiency decreases and right ventricular function becomes worse.

关 键 词：肺动脉高压 右心室-肺动脉耦联 三尖瓣环平面收缩期位移/肺动脉收缩压 心肺运动试验 通气效率 超声心动图 

分 类 号：R543.2[医药卫生—心血管疾病]