心肺运动试验比较三种肺动脉高压患者心肺功能状态的价值

Value of cardiopulmonary exercise testing in comparing cardio-pulmonary function among patients with three kinds of pulmonary artery hypertension

目的探讨心肺运动试验（CPET）比较3种肺动脉高压（PAH）患者心肺功能状态的价值。方法人选2012年12月至2013年5月入住阜外心血管病医院肺血管病诊治中心确诊的特发性PAH（特发组）、先天性心脏病性PAH（先心组）和结缔组织病相关性PAU（免疫组），均进行CPET，同时收集3组的一般资料、常规检查、氨基末端B型脑钠肽原（NT—proBNP）及6rnin步行距离（6MWD）等结果并进行比较分析。结果共入选特发组32例、先心组38例、免疫组25例。特发组、先心组、免疫组峰值氧耗量与体重的比值（VO，max／kg）分别为（12．3±2．3）、（14．9±4．0）、（11．1±2．5）ml·min-1·kg-1，3组间差异有统计学意义（P〈0．001），其中先心组显著高于其他两组（P=0．003，P〈0．001）；峰值氧脉搏（VO：与心率比值的峰值）分别为（5．8±1．4）、（6．4±1．8）、（5．3±1．7）ml·次-1·min-1，3组间差异亦有统计学意义（P=0．034），其中先心组显著高于免疫组（P=0．012）；峰值心率分别为（136．1±21．4）、（140．8±19．9）、（124．5±21．6）次／min，3组间差异有统计学意义（P=0．011），其中免疫组最低且显著低于先心组（P=0．009）。免疫组6MWD均显著低于特发组、先心组（P=0．006、0．010）；免疫组Nt—proBNP显著高于先心组（P=0．012）。VO，max／kg与峰值氧脉搏、峰值心率、峰值收缩压、6MWD、Nt—proBNP、左心室舒张末内径、右心室舒张末内径均显著相关（r=0．477、0．518、0．387、0．465、-0．350、0．349、-0．259）。结论CPET可以客观、定量地评价PAH的心肺功能状态和运动耐量。

Objective To assess the exercise capacity of three kinds of pulmonary artery hypertension using cardiopulmonary exercise testing （ CPET ） . Methods In the Center for Pulmonary Vascular Disease Diagnosis and Treatment of Fuwai Hospital, idiopathic pulmonary artery hypertension （IPAH）, congenital heart disease associated puhnonary artery hypertension （CHD-PAH）, connective tissue disease associated pulmonary artery hypertension （CTD-PAH） were enrolled into this study from December 2012 to May 2013. CPET was performed in all patients, and clinical features, routine tests results, N-terminal B-type natriuretic peptide （NT-proBNP）, Six-minutes-walk distance （6MWD） were all collected. Results Thirty-two patients with IPAH, 38 patients with CHD-PAH, 25 patients with CTD-PAH were enrolled. For IPAH, CHD-PAH, and CTD-PAH patients, the peak oxygen uptake via body weight （VO2max/kg） was （12.3±2.3）, （14.9±4.0）, and （11.1 ±2.5） ml. min-1. kg-1, respectively. The peak VO2/kg was significantly different within these three groups （P 〈 0. 001 ） , and was significantly higher in CHD-PAH patients compared with the other two groups （ P = 0. 003, P 〈 0. 001 ）. The peak VO2/heartrate （HR） was （5.8±1.4）, （6.4±1.8）, （5.3±1.7） ml . beat -1 . min-1 in the above three groups and was significantly different within these three groups （P = 0. 034）. The peak VOJHR wassignificantly increased in CHD-PAH patients than CTD-PAD patients （ P = 0. 012 ） . The peak HR was （ 136. 1±21.4 ）, （ 140. ± 19.9 ）, （ 124. 5± 21.6 ） beat/min respectively and was significantly lower in CTD-PAD patients than CHD-PAH patients （P = 0. 009）. The 6MWD was significantly decreased in CTD- PAD patients compared with CHD-PAH and IPAH patients （P = 0. 006, 0. 010） . Nt-proBNP was significantly decreased in CTD-PAD patients compared with CHD-PAH patients （P = 0. 012）. In Pearson and partial correlation analysis, the peak VO2/kg was significantly correlated with peak VO2/HR, peak HR, 6MWD, Nt-proBNP, left ventricular end-diastolic diameter, right ventricular end-diastolic diameter （r = 0. 477, 0. 518, 0. 387, 0. 465, - 0. 350, 0. 349, - 0. 259） . Conclusion CPET parameters can objectively evaluate exercise capacity and cardiopulmonary function of the patients with pulmonary hypertension.