运动后心率变化对评估慢性阻塞性肺疾病的肺功能分级的研究

Study of heart rate changes after exercise to evaluate pulmonary function classification in COPD patients

目的探讨运动后心率变化与慢性阻塞性肺疾病的肺功能受损严重程度之间的关系。方法选取安徽医科大学第一附属医院呼吸内科病房及门诊慢阻肺稳定期患者84例作为慢阻肺组,同时选取同年龄段21例健康体检者作为正常组。均行6min步行试验(6MWT),慢阻肺组以是否完成6MWT分为完成组及未完成组,分别记录运动后即时心率与静息心率差值HR动静及与休息1min心率差值HR R1,比较慢阻肺组与正常组、完成组及未完成组间不同肺功能分级慢阻肺患者间心率差值的差异性,分析其与肺功能指标的相关性。ROC曲线分析心率差值及6分钟步行距离(6MWD)预测慢阻肺患者肺功能分级价值。结果慢阻肺患者心率差值较正常人明显减低,无论6MWT完成组及未完成组,随着慢阻肺患者气流受限程度的加重,HR动静及HRR1逐渐减低(P<0.05)。完成组中6MWD、HR动静和HR R1与FEV1、FEV 1%pred均呈正相关,同样未完成组中HR动静、HRR1与FEV1、FEV1%pred呈正相关(P<0.05)。另外,完成组中6MWD、HR动静及HR R1预测患者重度慢阻肺阈值分别为372.25m,33.5次/分,22.5次/分,极重度患者分别为318m,19.5次/分,10.5次/分,未完成组中,HR动静和HRR1预测患者极重度慢阻肺的阈值分别为22.25次/分,10.5次/分。结论HR动静及HR R1可用于评估慢阻肺患者肺功能受损严重程度,特别是对于无法完成6MWT的慢阻肺患者,有助于病情评估,但在预测肺功能分级方面存在局限。

Objective To explore the relationship between the changes of heart rate after exercise and the severity of pulmonary function of COPD.Methods 84 patients with COPD in the respiratory department ward and outpatient department of the first affiliated hospital of Anhui medical university were selected as the COPD group,who were divided into the moderate,severe and extremely severe groups according to pulmonary function indicators.And 21 cases of healthy patients at the same age were selected as the normal group.All patients were given 6-minute walking test.Those completed 6MWT were taken as the finished group and those uncompleted as the unfinished group.Then their heart rate difference of instant heart rate after exercise and resting heart rate(HRar),and the heart rate recovery of instant heart rate after exercise and rest 1 min heart rate(HR R1)were recorded and compared among those groups.Their correlation with pulmonary function index was analyzed.ROC curve was used to analyze heart rate difference and 6-minute walking distance predicted pulmonary function in patients with COPD.Results The difference of heart rate of COPD patients was significantly reduced compared with normal patients,no matter in the 6MWT finished groups or the unfinished group.With the aggravation of airflow limitation in patients with COPD,their heart rate variation gradually decreased(P<0.05).In the finished group,6MWD and heart rate variation were positively correlated with FEV1 and FEV1%pred.While in the unfinished group,heart rate variation were positively correlated with FEV1 and FEV1%pred(P<0.05).In the finished group,the thresholds for predicting severe COPD patients with 6MWD,HRar and HR R1 were 372.25 m,33.5 times/min,and 22.5 times/min,respectively.The predicting value of extremely severe COPD patients with 6MWD,HRar and HR R1 were 318 m,19.5 times/min,and 10.5 times/min,respectively.In the unfinished group,the thresholds for predicting extremely severe COPD patients with HRar and HRR1 were 22.25 times/min and 10.5 times/min,respectively.Conclusion Heart rate variation can be used to evaluate the severity of pulmonary function of COPD patients,especially for patients with severity of COPD who cannot complete the 6MWT,which has certain value and helpful for the disease evaluation of patients with COPD,but it has limited value on pulmonary function classification.