冠心病患者运动耐量的影响因素分析

Influencing factors of exercise tolerance in patients with coronary heart disease

目的评估冠心病患者的运动耐量，探讨其影响因素。方法对2013年10月至2015年6月北京大学人民医院心血管内科经冠状动脉造影诊断冠心病并接受心肺运动试验（CPET）评估的136例患者的病历资料进行回顾性分析，根据峰值摄氧量占预计值的百分比（VO：peak％）水平，将136例患者分为运动耐量正常组（45例）及运动耐量减低组（91例）；比较2组患者性别、年龄、体重指数、吸烟史、既往史（高血压、糖尿病、心力衰竭、肺部疾病、心肌梗死等）等一般资料、CPET相关指标、左心室舒张末内径（LVEDd）及左心室射血分数（EF）的差异；分别比较有无心肌梗死、糖尿病病史及吸烟史者CPET相关指标的差异；采用logistic回归分析影响运动耐量的相关因素。结果运动耐量减低组年龄t〉65岁的比例低于运动耐量正常组，吸烟、糖尿病、心力衰竭、心肌梗死、行PC／比例明显高于运动耐量正常组，组间差异均有统计学意义[分别为13．2％（12／91）比33．3％（15／45）、49．4％（45／91）比31．1％（14／45）、42．9％（39／91）比20．0％（9／45）、25．3％（23／91）比6．7％（3／45）、64．8％（59／91）比33．3％（15／45）、81．3％（74／91）比64．4％（29／45），均P〈0．05]，余一般资料组问差异均无统计学意义（均P〉0．05）。运动耐量正常组和减低组患者峰值摄氧量分别为（26±4）和（20±3）ml／（kg·min），组间差异有统计学意义（t=7．914，P〈0．01）；有无心肌梗死病史的冠心病者峰值摄氧量分别为（21±4）、（23-4．4）ml／（kg·min），组问差异有统计学意义（t=2．093，P=0．038）；有无糖尿病史的冠心病者峰值摄氧量分别为（20±4）、（23±4）ml／（kg·min），二者问差异有统计学意义（t=3．573，P〈0．01）；有无吸烟史的冠心病者峰值摄氧量分别为（21±4）、（23±5）ml／（kg·min），二者间差异无统计学意义（t=1．494，P=0．138），V02peak％分别为（73±14）％、（82±19）％，二者间差异有统计学意义（t=2．983，P=0．003）。多因素logistics回归分析结果显示，糖尿病及心肌梗死病史为冠心病患者运动耐量减低的危险因素（糖尿病：OR=4．04，95％CI：1．283～12．721，P=0．017：心肌梗死：OR：6．80，95％CI：2．416—19．121，P〈0．01）。结论合并糖尿病和心肌梗死的冠心病患者的峰值摄氧量分别低于非糖尿病及既往无心肌梗死的冠心病患者。糖尿病、心肌梗死是冠心病患者运动耐量减低的独立危险因素。

Objective To investigate the influencing factors of exercise tolerance in patients with coronary heart disease. Methods A total of 136 patients who were diagnosed as coronary heart disease （CHD） by coronary angiography and underwent cardiopulmonary exercise testing （CPET） were enrolled. Exercise capacity was evaluated by peak oxygen consumption （VO2peak） value in CPET, patients were divided into exercise capacity normal group （n = 45） and abnormal group （n = 91 ） according to VO2 peak% value. Clinical manifestations, combined diseases, medications, CHD situations and ultracardiographic findings of patients were documented and the influencing factors were examined with multivariate logistic regression analysis. Results The rate of patients aged i〉 65 years in exercise capacity abnormal group waslower than that in normal group; the rates of smoking history, diabetes mellitus, heart failure, myocardial infarction,percutaneous coronary intervention （PCI）in exercise capacity abnormal group were higher than those in normal group [ 13.2% （ 12/91 ） vs. 33.3 % （ 15/45 ）, 49.4% （45/91 ） vs. 31.1% （ 14/45 ）, 42.9% （39/91）vs. 20.0% （9/45）, 25.3% （23/91）vs. 6.7% （3/45）, 64.8% （59/91）vs. 33.3% （15/45）, 81.3 % （74/91 ） vs. 64.4% （29/45）, respectively ; all P 〈 0.05 ]. The VO2 peak in exercise capacity normal group and abnormal group were （26 ±4） and （20 ± 3 ） ml/（ kg· min）, respectively（ t = 7. 914,P 〈 0. 01 ）. The VO2 peak in patients with myocardial infarction [ （21 ± 4）ml/（ kg· min） ] was lower than that without myocardial infarction [ （23 ±4）ml/（kg· min） ] （t =2. 093 ,P =0. 038）. The VO2peak in diabetes mellitus patients [ （20±4）mlf（kg· min）] was lower than that without diabetes [（23 ±4）ml/（kg· min）] （t = 3. 573,P〈0. 01）. The VO2peak between smokers and non-smokers was not significantly different （t = 1. 494,P =0. 138）, but the VO2peak % in smokers was significant lower than that in non-smokers[ （73 ± 14） % vs. （82 ± 19） %, t = 2. 983, P = 0. 003 ）. Multivariate logistic regression analysis showed that history of diabetes mellitus and history of myocardial infarction were the independent risk factors for the declined exercise capacity in CHD patients （ OR = 4. 04, 95 % CI： 1. 283 - 12. 721, P = 0. 017 ; OR = 6. 80,95 % CI： 2. 416 - 19. 121, P 〈 0. 01 ）. Conclusions The VO2peak in patients with diabetes or myocardial infarction are lower than that without diabetes or myocardial infarction. Diabetes and myocardial infarction are independent risk factors of declined exercise capacity in CHD patients.