重度左心衰患者弥散功能降低的临床研究报告

Preliminary study of clinical significance of decreased D_LCO in patients with left ventricular heart failure

目的:观察重度左心衰竭患者肺弥散功能(DLCO)变化的临床特点,探讨其潜在的病理生理学机制及其临床意义。方法:回顾性分析28例重度左心衰患者的临床资料、DLCO、肺通气功能和心肺运动试验指标。结果:左心衰竭患者的峰值摄氧量严重降低为34±7%pred和无氧阈为48±11%pred,DLCO中度降低为63±12%pred。28例患者有25例DLCO低于80%pred,而用力肺活量、第一秒用力肺活量、第一秒用力肺活量/用力肺活量和肺总量分别为75±14、71±17、97±11和79±13%pred,提示通气功能呈边界性至轻度限制性障碍。DLCO的下降幅度显著大于肺通气指标。结论:具有极严重心肺功能受限的重度心衰患者,DLCO显著降低和仅仅边界性轻度限制性通气受限。DLCO是心肺协同功能指标,在无明显呼吸受限前提下是反映循环功能受限的指标。

Objective： This study aimed to investigate the feature of DLCO （Diffusion Lung Capacity for Carbon Monoxide） in CHF （left ventricular heart failure） patients, underlying pathophysiological mechanism and clinical significance. Methods： We retrospectively studied the DLCO, pulmonary ventilation, function, cardiopulmonary exercise testing and related clinical information in severer HF patients. Results： Peak VO2 severely decreased to 34±7 percentage of predicted（%pred） and anaerobic threshold to 48±11%pred in all patients. DLCO moderately decreased to 63±12%pred and there were 25 patients lower than 80%pred. FVC, FEV1, FEVI/FVC and TLC were 75±14%pred, 71±17%pred, 97±11%pred, and 79±13%pred, which indicated borderline or mild restrictive ventilatory dysfunction. The decrease of DLCO was more severe than those of TLC, FEV1 and FVC. Conclusion： For patients with severe CHF, cardiopulmonary exercise function is extremely limited, DLCO generally moderately declines and ventilation function is merely mildly limited. DLCO is the parameter for cardiopulmonary coupling, reflecting limitation of the cardiovascular dysfunction while without ventilatory limit.