摄氧效率斜率预测特发性肺动脉高压预后

Oxygen Uptake Efficiency Slope Predicting the Prognosis in Patients With Idiopathic Pulmonary Arterial Hypertension

目的:评价摄氧效率斜率能否独立预测特发性肺动脉高压预后。方法:前瞻性连续入组2010-11到2015-06阜外医院新诊断特发性肺动脉高压患者,对患者进行定期随访,记录患者心血管事件(死亡和肺移植)。采用Kaplan-Meier曲线、单因素和多因素Cox比例风险回归模型进行生存分析。结果:210例特发性肺动脉高压患者完成了心肺运动试验并接受了定期随访,女性159例(75.7%)。在平均随访41个月后,31例患者出现死亡,1例患者接受肺移植。摄氧效率斜率与峰值摄氧量/体重呈明显正相关(r=0.71,P<0.0001)。多因素分析表明摄氧效率斜率指数和N末端B型利钠肽原(NT-pro BNP)可以独立预测患者预后。摄氧效率斜率指数≤0.52L/(min·m^2)患者5年生存率明显低于摄氧效率斜率指数>0.52L/(min·m^2)的患者(41.9%vs89.8%,P<0.0001)。结论:摄氧效率斜率作为一个亚极量心肺运动试验指标,可以很好的预测特发性肺动脉高压患者预后。

Objectives： To explore weather oxygen uptake efficiency slope （OUES） may predict the prognosis in patients with idiopathic pulmonary arterial hypertension （IPAH）. Methods： The consecutive newly diagnosed IPAH patients in our hospital from 2010-11 to 2015-06 were prospectively enrolled and regular follow-up study was conducted to record cardiovascular events （death and lung transplantation）. Kaplan–Meier curve, uni- and multivariate Cox regression analysis were performed to assess the survival rate in relevant patients. Results： A total of 210 IPAH patients at the mean age of （32±10） years were finished cardiopulmonary exercise test （CPET） and received regular follow-up study including 159 female. There were 31 patients died and 1 received lung transplantation over 41 months follow-up period. OUES was positively related to peak oxygen uptake （VO2）/body weight （r=0.71, P〈0.0001）. Multivariate analysis demonstrated that OUESI and NT-proBNP could independently predict the prognosis of IPAH patients. The 5-year survival rate in patients with OUESI≤0.52 L/（min·m^2） was lower than those with OUESI〉0.52 L/（min·m^2） （41.9% vs 89.8%）, P〈0.0001.Conclusion： OUES as a submaximal CPET parameter may well predict the prognosis in IPAH patients.