心肺运动试验在慢性血栓栓塞性肺动脉高压评估中的应用
赵智慧;柳志红;顾晴;罗勤;赵青;熊长明;倪新海
【期刊名称】《中华医学杂志》 【年(卷),期】2013(093)022
【摘要】目的 探讨心肺运动试验在慢性血栓栓塞性肺动脉高压(CTEPH)评估中的应用价值.方法 分析2010年11月至2012年12月,在阜外医院住院116例患者的临床资料,根据肺血栓栓塞症是否引起肺动脉高压进行分组,分别为CTEPH组44例、慢性肺血栓栓塞症(CPE)组24例和无肺血栓栓塞症及肺动脉高压的对照组48例,行氨基末端脑利钠肽前体(NT-proBNP)、心肺运动试验检查.分析3组间心肺功能状态的差别及NT-proBNP与各参数的相关性.结果 CTEPH组体质指数为(23.8±3.9)kg/m2显著小于CPE组和对照组的(26.1±3.6)和(26.7±3.2) kg/m2(均P＜0.05)；病程为(58±48)个月,显著长于CPE组和对照组的(12±10)和(29 ±25)个月(均P＜0.05)；NT-proBNP为(1678±1255) pmol/L,显著高于CPE组和对照组的(577±167)和(608±247) pmol/L(均P ＜0.05).心肺运动试验过程中及结束后无晕厥、病情加重等严重不良事件发生.CTEPH组峰值氧耗量(V02max)、VO2max占预计值的百分比(VO2％)及与体重的比值(VO2/kg)、无氧阈、氧脉搏均低于CPE组和对照组(均P＜0.05).CTEPH组和CPE组的生理死腔通气与潮气量比值均高于对照组(均P ＜0.05).NT-proBNP与心脏超声的右室内径(r=-0.690,P=0.000)、V02/kg(r=-0.496,P=0.000)呈负相关.右室内径(β=0.583,P=0.000)、V02/kg(β =0.233,P=0.032)是影响NT-proBNP的独立危险因素.结论 心肺运动试验客观、安全地评价CTEPH的心肺功能状态,能够反映CTEPH的病理生理变
化.%Objective To evaluate the application value of cardiopulmonary exercise testing in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods A total of 116 consecutive patients admitted into the Cardiology Department of Fuwai Hospital.They were divided into 3 groups of CTEPH (n =44),CPE (without pulmonary hypertension in chronic pulmonary embolism) (n =24) and control (without pulmonary embolism or pulmonary hypertension) (n =48) respectively.Their levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)were measured.Incremental cardiopulmonary exercise testing was performed to compare its differential results among 3 groups and evaluate the correlation between NT-proBNP and its parameters.Results The body mass index (BMI) in the CTEPH group was lower than those in the CPE and control groups ((23.8 ± 3.9) vs (26.1 ± 3.6) and (26.7 ± 3.2)kg/m2),both P ＜ 0.05) ; the medical history in the CTEPH group was longer than those in the CPE and control groups ((58 ±48) vs (12 ± 10) and (29 ±25) months,both P ＜0.05).The plasma concentrations of NT-proBNP in the CTEPH group were higher than those in the CPE and control groups ((1678 ± 1255) vs (577 ± 167) and (608 ± 247) pmol/L,both P ＜ 0.05).All of them completed the test and there were no severe complications such as syncope or exacerbation of disease.Maximum oxygen consumption (VO2max),percentage of predicted maximum oxygen consumption (VO2％),oxygen consumption
in relation to body weight (VO2/kg),anaerobic threshold and O2 pulse in the CTEPH group were significantly lower than those in the CPE and control groups (P ＜ 0.05).The ratios of dead space volume (VD) to tidal volume (VT) in the CTEPH and CPE groups were higher than those in the control group (P ＜ 0.05).The plasma concentrations of NT-proBNP were inversely correlated with right ventricular internal diameter (r =-0.690,P =0.000) and VO2/kg (r =-0.496,P =0.000).The right ventricular internal diameter (β =0.583,P=0.000) and VO2/kg (β =0.233,P =0.032) were strong independent determinants of NT-proBNP.Conclusion As a reliable pathophysiological indictor of CTEPH,cardiopulmonary exercise testing may be used objectively and safely to evaluate the cardiopulmonary function of CTEPH patients. 【总页数】4页(1687-1690)
【关键词】高血压,肺性;运动试验;肺栓塞
【作者】赵智慧;柳志红;顾晴;罗勤;赵青;熊长明;倪新海
【作者单位】100037 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 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 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 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 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
心肺运动试验在慢性血栓栓塞性肺动脉高压评估中的应用
