稳定期中重度慢性阻塞性肺疾病患者运动性低氧的发生情况及危险因素研究

Prevalence and Risk Factor Analysis of Exercise Induced Desaturation in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease at Stable Stage

目的了解肺功能Ⅱ级及以上稳定期慢性阻塞性肺疾病(COPD)患者中运动性低氧(EID)的发生情况,评价EID对COPD患者生活质量及BODE指数的影响。方法选取肺功能Ⅱ级及以上稳定期COPD患者,进行肺功能检查、6分钟步行试验(6MWT)、圣乔治呼吸问卷(SGRQ)及BODE评分。根据6MWT中有无EID分为伴EID组和无EID组,比较两组的生活质量、BODE指数等指标,评估发生EID的相关因素。结果共纳入肺功能Ⅱ级及以上稳定期COPD患者52例,平均年龄为(63±8)岁。EID的发生率为40.1%(21/52),其中肺功能Ⅱ级患者的EID发生率为18.2%(4/22);肺功能Ⅲ级患者的EID发生率为54.5%(12/22);肺功能Ⅳ级患者的EID发生率为62.5%(5/8);肺功能Ⅳ级患者EID发生率最高,与其他肺功能等级患者比较差异有统计学意义(P<0.05)。伴有EID的COPD患者与不伴EID的COPD患者相比较,二者在年龄、体质指数(BMI)、深吸气量占预计值百分比(IC%pre)、改良英国医学研究委员会呼吸困难量表(MMRC)得分、基线血氧饱和度(SPO2)、SGRQ总分、SGRQ呼吸症状评分、SGRQ疾病影响评分方面差异均无统计学意义(P>0.05);但在第一秒用力呼气容积占预计值百分比(FEV1%pre)、6分钟步行距离(6MWD)、6MWT中SPO2最低值、BODE指数和SGRQ活动受限评分上差异有统计学意义(P<0.05)。相关分析显示FEV1%pre(r=-0.329)、6MWD(r=-0.655)、SGRQ活动受限评分(r=0.328)、SPO2最低值(r=-0.445)、BODE指数(r=0.290)与EID发生具有相关性。进行Logistic回归分析后6MWD<350 m为EID的危险因素〔OR=18.77,95%CI(2.13,165.45),P=0.008〕。结论 EID的发生率随肺功能分级的增加而增高,伴有EID的COPD患者的6MWD、BODE指数、SGRQ活动受限评分更差。6MWD<350 m可作为EID发生的危险因素。

Objective To investigate the prevalence rate of exercise induced desaturation （EID） in patients with chro- nic obstructive pulmonary disease （COPD） at stable stage and whose pulmonary function classification was level II or above, and to evaluate the influence of EID on their quality of life （QOL） and body mass index, airflow obstruction, dyspnea and exercise capacity （BODE） index. Methods The COPD patients at stable stage and with the pulmonary function classification of level II or above were selected. The pulmonary function test, 6 minute walking test （6MWT）, St. George＇s questionnaire （SGRQ） and BODE index were performed for all the patients. Then the patients were divided into EID group and non - EID group according to the existence of EID in 6MWT. The QOL and BODE index of the two groups were compared to evaluate the risk factors of EID in COPD. Results Totally 52 eligible patients were enrolled, with their average age being （63 - 8 ） years. The prevalence rate of EID was 40. 1% （21/52） . The prevalence rates of EID in patients with pulmonary function of level II, III, and IV were 18. 2% （4/22）, 54. 5% （ 12/22）, and 62. 5% （5/8）, with the prevalence rate of EID being highest in patients with pulmonary function of level IV （ P 〈 0.05 ） . Compared with COPD patients without EID, those with EID showed no significant difference in a- ges, body mass index （BMI）, predictive percentage of inspiratory capacity （IC% pre）, modified British medical research coun- cil （MMR, C） score, baseline oxygen saturation and SGRQ score; however the differences in FEV, % pre, 6MWD, minimum of the oxygen saturation in 6MWT, BODE index and activity limitation score of SGRQ revealed significant （ P 〈0. 05 ） . Correlation analysis showed that the occurrence of EID was correlated with predictive percentage of FEV, （ FEV, % pre） （ r = - 0. 329 ）, 6MWD （r = -O. 655 ）, activity limitation score of SGRQ （r = O. 328）, minimum of the oxygen saturation （r = -0. 445 ）, and BODE index （ r = 0. 290） . Logistic regression analysis revealed that 6MWD 〈 350 m is a risk factor of EID [ OR = 18.77, 95 % CI （2. 13, 165.45）, P = 0. 008 ] . Conclusion The prevalence of EID increases with the increase of the pulmonary function levels. The patients with EID present with lower 6MWD, BODE index and SGRQ activity limitation score.