肥胖症患者心肺运动试验指标特点分析

Analysis of characteristics of cardiopulmonary exercise test indexes in obese patients

目的探讨肥胖症患者心肺运动试验指标特点,进一步明确其病理生理的变化特征,指导减重训练,预防疾病的发生和发展。方法选择昆明医科大学附属心血管病医院2020年4月至6月肥胖症患者71例(肥胖组),其中男性43例,女性28例;年龄21~71岁,平均年龄49.03岁。同期选择BMI正常者181例(非肥胖组),其中男性107例,女性74例;年龄25~79岁,平均年龄50.88岁。分析心肺运动试验检查数据,统计患者行心肺运动试验过程中的峰值负荷(Load peak)、峰值摄氧量(VO_(2)peak)、峰值千克摄氧量(VO;/kg)、无氧阈(AT)、峰值摄氧量占预计值的百分比(VO_(2)peak/pre)、峰值代谢当量(Mets peak)、无氧阈时的代谢当量(Mets@AT)、心率储备(HRR)、呼吸储备(BR)、静息心率(HRrest)、最大心率(HRmax)、最大心率占预计值的百分比(HRmax/pre)、1 min心率恢复(HRR-1 min)、最大氧脉搏(VO_(2)/HRmax)、氧脉搏占预计值的百分比、氧通气当量(VE/VO_(2))、二氧化碳通气当量(VE/VCO2)的值。结果心肺运动试验过程中,肥胖组Load peak、VO_(2)peak、HRR和氧脉搏占预计值的百分比均显著高于对照组[(132.09±38.38) W vs (117.24±36.06) W、(1 421.98±343.72) mL/min vs (1 190.06±335.01) mL/min、(37.94±19.91)次/分vs (27.72±15.19)次/分、(92.02±20.96)%vs (84.30±16.69)%;P <0.01];肥胖组VO_(2)/kg、AT、Mets peak、Mets@AT、BR、HRmax、HRmax/pre和HRR-1 min显著低于对照组(P <0.05);而两组间VO_(2)peak/pre、HRrest、VE/VO_(2)和VE/VCO2指标比较,差异无统计学意义(P> 0.05)。结论肥胖组患者VO_(2)peak及氧脉搏占预计值的百分比均高于非肥胖组人群,而VO_(2)/kg却低于正常者,机体摄氧仍然相对不足。

Objective To investigate the characteristics of cardiopulmonary exercise test(CPET) in obese patients, and further clarify pathophysiological changes for guiding body mass loss training and preventing occurrence and development of diseases.Methods From April to June 2020, 71 obese patients(obese group) were enrolled, which included 43 males and 28 females,aged 21-71 years old with mean age of 49.03 years old. In the same period, 181 cases with normal body mass index(BMI)were enrolled and set as non-obese group, which included 107 males and 74 females, aged 25-79 years old with mean age of 50.88 years old. The cardiopulmonary exercise test data were analyzed and statistically calculated in Load peak, peak oxygen uptake(VO_(2)peak), peak kilogram oxygen uptake(VO_(2)/kg), anaerobic threshold(AT), peak oxygen uptake accounted for expected value percentage(VO_(2)peak/pre), peak metabolic equivalent(Mets peak), metabolic equivalent at anaerobic threshold(Mets@AT), heart rate reserve(HRR), breathing reserve(BR), rest heart rate(HRrest), maximum heart rate(HRmax), maximum heart rate as percentage of expected value(HR max/pre), 1 minute heart rate recovery(HRR-1 min), maximum oxygen pulse(VO_(2)/HRmax), oxygen pulse accounted for percentage of predicted value, ventilation equivalent for VO_(2)(VE/VO_(2)), ventilation equivalent for VCO;(VE/VCO;). Results During cardiopulmonary exercise test, the percentages of Load peak, VO_(2)peak, HRR and oxygen pulse accounted for percentage of predicted value in obese group were significantly higher than those in non-obese group[(132.09 ± 38.38) W vs(117.24 ± 36.06) W,(1 421.98 ± 343.72) mL/minutes vs(1 190.06 ± 335.01) m L/minutes,(37.94 ±19.91) times/minutes vs(27.72 ± 15.19) times/minutes,(92.02 ± 20.96) % vs(84.30 ± 16.69) %;P < 0.01];VO_(2)/kg, AT, Mets peak, Mets@AT, BR, HRmax, HRmax/pre and HRR-1 min in obese group were significantly lower than those in non-obese group(P < 0.05). There was no significant difference in VO_(2)peak/pre, HR rest, VE/VO_(2)and VE/VCO;of 2 groups(P > 0.05).Conclusion It is demonstrated that the VO_(2)peak and oxygen pulse accounted for percentage of predicted value of obese patients are higher but VO_(2)/kg is lower than normal, and body oxygen intake is still relatively insufficient.