心肺运动试验参数预测慢性血栓栓塞性肺动脉高压患者心输出量的性别差异性

Sex differences of cardiopulmonary exercise testing parameters in cardiac output prediction for patients with chronic thromboembolic pulmonary hypertension

目的:探究心肺运动试验(CPET)参数评估慢性血栓栓塞性肺动脉高压(CTEPH)患者心输出量的性别差异性特征。方法:回顾性纳入了来自2010年5月至2016年2月上海市肺科医院肺循环科初次住院治疗的73例成年CTEPH患者(男32例,女41例),以是否发生临床恶化事件为标准进行亚组分析。所有患者均进行了CPET及右心导管检查。多元线性回归分析心输出量降低的独立预测因素。结果:女性CTEPH患者较男性患者年轻( P<0.05),其他一般资料与血流动力学参数在两性患者中的差异无统计学意义。男性患者较女性有较高的无氧域点氧脉搏、峰值分钟通气量和无氧域点呼气末氧分压、峰值氧脉搏和无氧域点分钟通气量以及二氧化碳通气当量最低点( P值均<0.05),而女性患者的摄氧效率平台较高( P<0.05)。在亚组分析中,男性患者的CPET参数在有恶化事件组和无恶化事件组中差异无统计学意义,而峰值摄氧量在女性患者有恶化事件组中显著降低( P<0.05)。此外,与男性有恶化事件组比较,女性有恶化事件组的峰值摄氧量、无氧域点分钟通气量和峰值分钟通气量相对较低( P值均<0.05)。二氧化碳通气当量最低点和峰值呼气末氧分压分别是预测男性和女性CTEPH患者心输出量的独立预测因子。 结论:CPET参数评估男性和女性CTEPH患者心输出量的独立预测因子不同,提示将CPET的性别差异纳入CTEPH患者的临床评估中可使更多患者受益。

Objective To evaluate the sex differences of cardiopulmonary exercise testing(CPET)parameters in cardiac output(CO)prediction for patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods From May 2010 to February 2016,73 cases(32 males and 41 females)with CTEPH were enrolled from Shanghai Pulmonary Hospital,all of whom underwent both right-heart catheterization and CPET.Multivariate regression analysis was applied to assess the prognostic value of CPET parameters.Results Sex differences were of no significance in both demographic and hemodynamic parameters in total patients,but younger in female patients.Male patients had higher O2 pulse at anaerobic threshold(AT),peak minute ventilation(VE),end-tidal partial pressure of oxygen output(PETO2)at AT,peak O2 pulse,VE at AT and nadir VE/carbon dioxide(VCO2),but lower oxygen uptake efficiency slope compared with female patients(all P<0.05).There was no significant difference in CPET parameters between male event group and male event-free group,but peak oxygen uptake(VO2)in female event group was lower than that in female event-free group(P<0.05).Female event group had lower peak VO2,VE at AT and peak VE compared to the male event group(all P<0.05).Nadir VE/VCO2 and peak PETO2 were independent predictors of CO for male and female CTEPH patients,respectively.Conclusions The independent predictors of CPET parameters are different in the assessment of CO in male and female CTEPH patients,which suggests that sex differences of CPET should be considered to be the better clinical assessment of CTEPH patients.