房颤患者的运动病理生理学特征的临床研究

A clinical research:the characteristics of exercise pathophysiology in patients with atrial fibrillation

目的:旨在通过心肺运动试验(CPET)对房颤(AF)的运动病理生理学特征进行探讨。方法:回顾性分析自2018年9月至2021年4月在北京阜外医院就诊,签署知情同意后完成规范化CPET极限运动的AF患者137例,并选取同期年龄、性别与之相近的正常人35例为对照组。将AF患者的CPET核心指标按照标准方法分析计算,与正常人比较,进行统计学独立样本t检验。同时将AF患者按是否存在心衰分为两个亚组,比较各组CPET核心指标的组间差异(正常组35例,无心衰组41例,AF伴心衰组96例)。结果:①AF患者CPET峰值摄氧量(peakVO_(2))为(57.18±18.00)%pred,无氧阈值摄氧量(AT)为(73.24±16.95)%pred,峰值氧脉搏(peakVO_(2))为(65.11±20.05)%pred,摄氧通气有效峰值平台(OUEP)为(90.76±17.82)%pred,均显著低于正常人(P均<0.001);而二氧化碳排出通气比值最低值(lowest VE/VCO_(2))为(121.71±27.07)%pred,排出通气斜率(VE/VO_(2)slope)为(129.83±50.03)%pred,均显著高于正常人(P均<0.001)。②在静息、热身、AT、峰值及恢复2min等时期,各CPET核心指标均表现为先缓后陡的上升趋势,并在恢复期快速下降;AF组上升趋势均低于正常组,且下降缓慢。AF患者在峰值期的VO_(2)、HR、VO_(2)/HR、SBP、VE和VT均显著低于正常人。③AF非心衰组的peakVO_(2)、peakVO_(2)/HR、AT和OUEP均显著高于AF伴心衰组(P<0.01);Lowest VE/VCO_(2)和VE/VCO_(2)slope均显著低于AF伴心衰组(P<0.001)。④相关性分析显示peakVO_(2)和AT与NYHA分级呈负相关[(r=﹣0.722,P<0.0001);(r=﹣0.528,P<0.0001)];BE/VCO_(2)slope与NYHA分级呈正相关(r=0.581,P<0.01)。结论:CPET检查结果显示,与正常人相比,AF患者的运动生理学反应显著异常;主要体现在运动中反映呼吸循环系统和整体功能的各项指标的异常。

Objective:To investigate the characteristics of exercise pathophysiology in patients with atrial fibrillation(AF)through cardiopulmonary exercise testing(CPET).Method:A total of 137 AF patients,who performed ramp incremental loading program CPET in Fuwai hospital from September 1,2018 to April 1,2021,were selected and divided into two groups:AF-NHF group(without chronic heart failure,41 patients)and AF-HF group(with chronic heart failure,96 patients).Thirty five healthy volunteers served as controls(NS group).The core parameters of CPET were measured and compared.Result:①The peakVO_(2)[(57.18±18.00)%pred],AT[(73.24±16.95)%pred],peakO_(2)pulse[(65.11±20.05)%pred],OUEP[(90.76±17.82)%pred]of patients with AF were significantly lower than those of normal subjects(NS,all P values were<0.001).The lowest VE/VCO_(2)and VE/VCO_(2)slope of AF were significantly higher than those of NS.②During the five different stages of the CPET,almost all of the core parameters in both NS and AF groups showed an rising trend which was at slow first and then sharp,and dropped rapidly at the recovery stage.Compared to NS,the rising range was lower and the recovery speed was slower in AF.At the peak stage of CPET,VO_(2),HR,O_(2)pulse,SBP,VT,and VTin AF were lower than those in NS.③The peakVO_(2),peakO_(2)pulse,AT,and OUEP in AF-NHF were significantly higher than those in AF-HF(P<0.01).The lowest VE/VCO_(2)and VE/VCO_(2)slope in AF-NHF were significantly lower than those in AF-HF(P<0.001).④The peakVO_(2)and AT were negatively correlated with a higher NYHA grade[(r=﹣0.722,P<0.0001);(r=﹣0.528,P<0.0001)];The VE/VCO_(2)slope was positively correlated with a higher NYHA grade(r=0.581,P<0.0001).Conclusion:According to the results of CPET,the exercise physiological response in patients with AF was abnormal,which were mainly reflected by abnormal parameters of respiratory and holistic integrative function during exercise.