心肺运动试验评估慢性血栓栓塞性肺动脉高压患者心肺功能的临床观察研究

Clinical Observation of Cardiopulmonary Exercise Testing in Patients with Chronic Thromboembolic Pulmonary Hypertension

目的探讨心肺运动试验在慢性血栓栓塞性肺动脉高压(CTEPH)患者心肺功能评估中的应用价值。方法选取2009年1月—2013年10月河南省人民医院收治的慢性血栓栓塞性疾病患者72例,根据是否引起肺动脉高压分为CTEPH组45例,慢性血栓栓塞症(CPE)组27例,并选取同期52例心肺功能正常的人群作为对照组。3组均进行心肺运动试验,分析3组患者间心肺功能指标的差别以及氨基末端脑钠肽前体(NT-pro BNP)与心肺功能指标的相关性。结果 CTEPH组NT-pro BNP水平为(1 564±1 031)pmol/L,高于CPE组和对照组的(595±159)pmol/L和(605±167)pmol/L(P<0.05)。3组潮气末氧分压(PetO_2)、潮气末二氧化碳分压(PetCO_2)、峰值耗氧量(VO_2max)、VO_2max与体质量的比值(VO_2/kg)、氧脉搏、无氧阈、氧通气当量(VE/VO_2)、二氧化碳通气当量(VE/VCO_2)、呼吸无效腔/潮气量比值(VD/VT)、VE/VCO_2斜率比较,差异均有统计学意义(P<0.05);其中CPE组PetCO_2、VO_2/kg低于对照组,VE/VO_2、VE/VCO_2、VD/VT、VE/VCO_2斜率高于对照组;CTEPH组PetCO_2、VO_2max、VO_2/kg、氧脉搏、无氧阈低于对照组和CPE组,VE/VO_2、VD/VT、VE/VCO_2斜率高于对照组和CPE组,PetO_2、VE/VCO_2高于对照组(P<0.05)。多元线性回归分析结果显示,VO_2/kg(β=-0.213,t=-4.436,P<0.001)和右心室前后径(RV)(β=0.561,t=4.209,P<0.001)是影响NT-pro BNP水平的独立影响因素。结论心肺运动试验可以客观定量地评价CTEPH患者的心肺功能。

Objective To evaluate the application value of cardiopulmonary exercise testing in patients with chronic thromboembolic pulmonary hypertension（CTEPH）.Methods From January 2009 to October 2013,a total of 72 cases with chronic thromboembolic disease admitted in the People′s Hospital of Henan were enrolled.According to whether it caused pulmonary hypertension,the patients were divided into 2 groups：CTEPH group of 45 cases and chronic thrombosis（CPE） group of 27 cases.And 52 patients with normal cardiopulmonary function in the same period were selected as the control group.All the 3 groups underwent cardiopulmonary exercise testing.The differences of cardiopulmonary function parameters among the three groups were compared and the correlation between the amino-terminal brain natriuretic peptide（NT-proBNP） and cardiopulmonary function parameters were analyzed.Results The plasma concentrations（1 564±1 031）pmol/L of NT-proBNP in the CTEPH group were higher than those in the CPE（595±159）pmol/L and control groups （605±167）pmol/L（both P〈0.05）.The PetO2,PetCO2,VO2max,VO2/kg,oxygen pulse,anaerobic threshold,VE/VO2,VE/VCO2,VD/VT,VE/VCO2 slope among the 3 groups were compared and the differences were statistically significant（P〈0.05）.The PetCO2 and VO2/kg in the CPE group were significantly lower than those in the control group.The VE/VO2,VE/VCO2,VD/VT,and VE/VCO2 slope in the CPE group were significantly higher than those in the control group.The PetCO2,VO2max,VO2/kg,oxygen pulse,and anaerobic threshold in the CTEPH group were significantly lower than those in the control and CPE groups.The VE/VO2,VD/VT,and VE/VCO2 slope in the CTEPH group were higher than those in the control and CPE groups.The PetO2,VE/VCO2 in the CTEPH group were higher than those in the control group（P〈0.05）.Multiple linear regression analysis showed that VO2/kg （β=-0.213,t=-4.436,P〈0.001）and the right ventricular internal diameter（β=0.561,t=4.209,P〈0.001）were independent influencing factors affecting NT-proBNP levels.Conclusion Cardiopulmonary exercise testing could objectively and quantitatively evaluate the exercise capacity in patients with CTEPH.