慢性阻塞性肺疾病稳定期患者的摄氧效率与运动耐力的关系研究

Correlation studies between oxygen uptaking efficiency and exercise endurance of patients with stable chronic obstructive pulmonary disease

目的：探讨摄氧效率与 COPD 稳定期患者运动耐力的相关性。方法选择2013年1月至2014年12月 COPD 稳定期患者50例为研究对象，50例患者中，按照病情严重程度，Ⅰ～Ⅱ级28例，Ⅲ～Ⅳ级22例；选择2013年1月至2014年12月50例 COPD 急性期患者为疾病对照组；选择2013年1月至2014年12月健康人群50名为健康对照组。检测研究对象用力肺活量（FVC）、第一秒用力呼气容积（FEV1）、FEV1／FVC、峰值摄氧量（peak VO2）、峰值摄氧量占预计值（peak VO2％pred）、摄氧效率斜率（OUES）、摄氧效率平台（OUEP）、无氧阈时的摄氧效率（OUE＠AT）等指标，并对摄氧效率及运动耐力进行相关性分析。结果COPD组 FVC、FEV1、FEV1／FVC 等指标数值均小于对照组，差异有统计学意义（均 P ＜0.05），且 COPD 急性期患者FVC（2．86±0．36）L、FEV1（1．25±0．36）L、FEV1／FVC（50．16±5．37）％等指标数值均小于 COPD 稳定期的（3．12±0．46）L，（1．51±0．38）L，（60．16±6．16）％，差异有统计学意义（F ＝5．62、6．52、7．18，均 P ＜0．05）。COPD 组 peak VO2、peak VO2％pred、OUES、OUEP、OUE＠AT 等指标数值均小于对照组，差异有统计学意义（均 P ＜0．05），且 COPD 急性期患者 peak VO2（1072．35±271．21）mL／min、peak VO2％pred（62．79±6．31）、OUES（1．59±0．29）、OUEP（25．72±3．42）、OUE＠AT（26．75±3．12）等指标数值均小于 COPD 稳定期的（1190．67±286．21）mL／min，（70．76±6．27），（1．89±0．31），（31．46±4．05），（31．62±3．16），差异有统计学意义（F ＝15．16、9．79、6．15、8．76、8．92，均 P ＜0．05）。随着 COPD 稳定期患者病情严重程度的加重，peak VO2、peak VO2％pred、OUES、OUEP、OUE＠AT 呈逐渐下降趋势[（1089．62±221.68）mL／min 比（1236．75±235．37）mL／min，（67．28±5．03）比（75．81±5．39），（1．62±0．18）比（2．04±0．25），（30．67±6．47）比（34．17±4.40），（30．31±3．42）比（36．59±3．63），F ＝16．92、12．71、4．27、8．75、7.59，均 P ＜0．05]。COPD 稳定期患者OUES、OUEP、OUE＠AT 等摄氧效率指标与运动耐力指标 peak VO2％pred 均呈正相关（r ＝0．451、0．462、0.429，P ＝0．019、0．012、0．26），与 peak VO2均呈正相关（r ＝0．446、0．452、0．417，P ＝0．023、0．011、0．29）。结论COPD 患者摄氧效率及运动耐力均较健康人群降低，COPD 患者摄氧效率及运动耐力与 COPD 病情及严重程度有关，而 COPD 患者运动耐力对摄氧效率亦存在一定程度的影响。

Objective To study correlation between oxygen uptaking efficiency and exercise endurance of patients with stable chronic obstructive pulmonary disease （COPD）.Methods From January 2013 to December 2014,50 patients with COPD plateau were selected as the research subjects,and according to the severity,28 cases of gradeⅠ -Ⅱ,22 cases of grade Ⅲ -Ⅳ.50 COPD patients with acute phase of disease were selected as disease control group.50 healthy people were selected as healthy control group.The forced vital capacity （FVC）,forced expiratory volume in first second （FEV1 ）,FEV1 /FVC,peak oxygen uptake （peak VO2 ）,peak oxygen uptake of expected value （peak VO2% Mr Pred）,oxygen uptake efficiency slope （OUES）,oxygen uptake efficiency platform （OUEP）,when the anaerobic threshold （OUE @ AT）such as index,and the oxygen uptake efficiency and movement endurance were detected and analyzed.Results FVC,FEV1 ,FEV1 /FVC index values of COPD group were less than those of the control group,the differences were statistically significant （all P〈0.05）,and COPD patients with acute phase of FVC（2.86 ±0.36）L,FEV1 （1.25 ±0.36）L,FEV1 /FVC（50.16 ±5.37）% index values were less than COPD stabilization [（3.12 ±0.46）L,（1.51 ±0.38）L,（60.16 ±6.16）%）],the differences were statistically significant （all P〈0.05）.The peak VO2 ,peak VO2% Mr Pred,OUES,OUEP,OUE @ AT index values of COPD group were less than those of the control group,the differences were statistically significant （all P〈0.05）,and COPD patients with acute phase of peak VO2 （1 072.35 ±271.21）mL/min,peak VO2%pred（62.79 ±6.31）,OUES（1.59 ±0.29）,OUEP （25.72 ±3.42）,OUE@AT（26.75 ±3.12）index values were less than patients with COPD stabilization[（1190.67 ± 286.21）mL/min,（70.76 ±6.27）,（1.89 ±0.31 ）,（31.46 ±4.05 ）,（31.62 ±3.16）],the differences were statistically significant （all P〈0.05）.As the stabilization of disease severity in patients with COPD was aggravated, peak,VO2 peak VO2% Mr Pred,OUES,OUEP,OUE @ AT declined （1 089.62 ±221.68）mL/min vs.（1236.75 ± 235.37）mL/min,（67.28 ±5.03）vs.（75.81 ±5.39）,（1.62 ±0.18）vs.（2.04 ±0.25）,（30.67 ±6.47）vs. （34.17 ±4.40）,（30.31 ±3.42）vs.（36.59 ±3.63）（F =16.92,12.71,4.27,8.75,7.59,P〈0.05）.Patients with COPD stabilization OUES,OUEP,OUE @ AT peak oxygen uptake efficiency indexes and movement endurance targets were positively correlated with VO2% Mr Pred （r =0.451,0.462,0.451,P =0.019,0.012,0.26）,there was a positive correlation with peak VO2 （r =0.446,0.452,0.446,P =0.023,0.011,0.29）.Conclusion COPD patients oxygen uptake efficiency and movement endurance than healthy people,patients with COPD oxygen uptake efficiency and movement endurance is associated with illness and severity of COPD,and COPD patients exercise endurance on the oxygen uptake efficiency also has a certain degree of influence.