肥厚型心肌病患者在心肺运动中核心指标的特征性研究

The characteristics of core parameters during cardiopulmonary exercise testing in patients with hypertrophy cardiomyopathy

目的:肥厚型心肌病(HCM),以心肌肥厚为主要特征的心肌疾病,猝死率高。临床症状表现为呼吸困难、乏力、胸痛等。症状限制性极限运动心肺运动试验(CPET)在整体整合生理和医学(HIPM)理论指导下是唯一评估人体整体功能状态检查,肥厚型心肌病患者在心肺运动中核心数据变化值得进一步探讨。方法:选择2017年4月至2020年1月在阜外医院就诊签署知情同意书后完成CPET受试者244例为研究对象,其中219例肥厚型心肌病(肥厚心组)和无诊断疾病健康人25例(正常组),观察两组CPET核心指标的异同。结果:①肥厚心组男163女56例,正常组11男14女;肥厚心组年龄(46.7±12.8,16.0~71.0)岁;正常组年龄(43.7±10.4,26.0~61.0)岁。②肥厚心组CPET核心指标的峰值摄氧量(Peak VO_(2))为(65.2±13.8,22.8~103.4)%pred;无氧阈(AT)为(66.4±13.0,33.7~103.5)%pred;峰值氧脉搏(Peak O_(2) pulse)为(84.3±19.0,90.9~126.0)%pred;摄氧效率平台(OUEP)为(99.2±13.4,69.1~155.5)%pred;分钟通气量和二氧化碳排出量比值最小值(Lowest V_(E)/VCO_(2))为(108.0±13.2,70.4~154.0)%pred;分钟通气量和二氧化碳排出量比值斜率(V_(E)/VCO_(2) Slope)为(108.5±17.9,66.9~164.9)%pred,肥厚心组较正常组在峰值摄氧量,无氧阈,峰值氧脉搏,摄氧效率平台等百分预计值(%pred)等指标均显著降低(P<0.01或P<0.05);而Lowest V_(E)/VCO_(2)和V_(E)/VCO_(2) Slope(%pred)显著升高(P<0.05),差异均有统计学意义。个体而言,部分患者就诊时整体功能状态尚在正常范围内。③CPET中Peak VO_(2)与其他核心指标AT、OUEP、Peak O_(2) pulse、峰值收缩压呈正相关;与Lowest V_(E)/VCO_(2)和V_(E)/VCO_(2) Slope呈负相关。结论:肥厚型心肌病患者能安全完成CPET,CPET指标具有特异性,不仅可用于整体功能评测、疾病诊断与鉴别诊断、危险分层、疗效评估和精准预后预测,并可用于整体论指导下的个体化整体方案慢病有效管理,值得进一步深入研究和临床推广应用。

Objective:The patients with Hypertrophic CardioMyopathy(HCM),characterized by hypertrophy of the myocardium with a high risk of sudden death,was less clear for the exercise pathophysiology.Under the guidance of holistic integrative physiology and medicine(HIPM),the ramp protocol symptom-limited CardioPulmonary Exercise Testing(CPET)is the only method to evaluate the overall functional status of human body.We investigated the CPET pathophysiology in patients with HCM.Methods:From April 2017 to January 2020,244 subjects were enrolled after signed the informed consent form and completing CPET in Fuwai Hospital.They 219 HCM patients and 25 healthy normal subjects as control(NS).The changes of CPET core parameters between two them were calculated,compared and did Individual analysis.Results:①The gender of HCM was 163 maleand 56 female.The gender of NS was 11 male and 14 female.The age of HCM was(46.7±12.8,16.0~71.0)year;NS was(43.7±10.4,26.0~61.0)year.②The core CPET parameters of HCM:peak oxygen uptake(Peak VO_(2))was(65.2±13.8,22.8~103.4)%pred;anaerobic threshold(AT)was(66.4±13.0,33.7~103.5)%pred;Peak O_(2) pulse was(84.3±19.0,90.9~126.0)%pred;oxygen uptake efficiency platform(OUEP)was(99.2±13.4,69.1~155.5)%pred;Lowest V_(E)/VCO_(2) was(108.0±13.2,70.4~154.0)%pred;V_(E)/VCO_(2) Slope was(108.5±17.9,66.9~164.9)%pred.Compared with NS,the Peak VO_(2),AT,Peak O_(2) pulse,and OUEP were significantly decreased(P<0.01 or P<0.05),but the Lowest V_(E)/VCO_(2) and V_(E)/VCO_(2) Slope were significantly increased(P<0.05).For Individual analysis of the overall functional status of CPET,some were very sever but some HCM were still within the normal range.③The Peak VO_(2) was positively correlated with AT,OUEP,Peak O_(2) pulse,and peak systolic blood pressure,but was negative correlated with Lowest V_(E)/VCO_(2) and V_(E)/VCO_(2) Slope.Conclusion:CPET is safe and specific characteristics for patients with HCM,which deserve further research and clinical application.Under HIPM guidance,CPET can not only be used for overall functional evaluation,disease diagnosis and differential diagnosis,risk stratification,curative effect evaluation and accurate prognostic prediction,but also be utilized in formulating the individualized training prescription and management of chronic diseases.