维持性血液透析患者运动耐量的影响因素分析

Factors influencing exercise tolerance in maintenance hemodialysis patients

目的 采用心肺运动试验(cardiopulmonary exercise testing,CPET)评估维持性血液透析(maintenance hemodialysis,MHD)患者运动耐量水平,并采用多重线性回归分析其独立影响因素。方法 纳入2019年12月至2021年4月同济大学附属同济医院肾内科MHD患者121例,行症状限制性递增功率踏车运动测试,记录患者的一般资料、疾病相关资料及实验室指标,与CPET的监测数据合并,建立数据集。以峰值摄氧量为因变量,CPET其余指标为自变量建立多重线性回归模型。结果 纳入121例MHD患者,男85例(70.2%),年龄范围28~78岁,峰值摄氧量为(12.17±2.56)mL·kg^(-1)·min^(-1)。以“逐步法”构建的多重线性回归模型显示,拟合的回归方程差异具有统计学意义(F=44.345,P<0.001);峰值负荷(β=0.063,P<0.001)、呼吸储备(β=-0.105,P<0.001)、峰值心率(β=0.024,P=0.003)及二氧化碳通气当量斜率(β=-0.153,P<0.001)是MHD患者峰值摄氧量的独立影响因素。结论 MHD患者的骨骼肌功能、肺通气、心肺偶联的通气效率及心功能是其运动耐量的独立影响因素。

Objective To observe the level of exercise tolerance among maintenance hemodialysis(MHD)patients using the cardiopulmonary exercise test(CPET)and analysis the factors influencing it.Methods From December 2019 to April 2021,121 maintenance hemodialysis(MHD)patients were recruited for cardiopulmonary exercise testing.General profiles,medical history,laboratory indicators and parameters of CPET were recorded to establish a data set.Take peak respiratory uptake as the dependent variable and other indicators of CPET as independent variables for multiple liner regressions analysis.Results A total of 121 patients were recruited.There were 85 males and 36 females with an age range of(28-78)years.Peak respiratory uptake was(12.17±2.56)mL·kg^(-1)·min^(-1).Multiple linear regression model as constructed by“stepwise method”indicated that the fitted multiple liner regression equation was statistically significant(F=44.345,P<0.001).Furthermore,average peak power(β=0.063,P<0.001),breathing reserve(β=−0.105,P<0.001),peak heart rate(β=0.024,P=0.003)and slope of VE-VCO_(2) curve(β=−0.153,P<0.001)were all significant independent predictors of peak respiratory uptake.Conclusions Skeletal muscle power,pulmonary ventilation,ventilation efficiency and cardiac function are independent predictors for exercise tolerance in MHD patients.