摘要
目的比较心肺运动试验测定峰值氧耗量（VO2max）与纽约心功能分级（NYHA）、6min步行距离（6MWD）和氨基末端利钠肽前体（NT—proBNP）与心脏指数（CI）的相关性，了解VO2max在评价肺动脉高压患者心功能中的作用。方法入选经右心导管检查确诊的第一、四和五大类肺动脉高压患者，比较VO2max和6MWD、NYHA心功能分级、NT—proBNP与CI的相关性。以CI2．2L·min-1·11112为界点，采用ROC曲线分析法确定VO2max评价重度心功能不全的阈值。结果共入选肺动脉高压患者101例，男性29例，女性72例，平均年龄（32．6±11．4）岁。NYHA心功能Ⅱ级44例（43．6％），Ⅲ级49例（48．5％）；6MWD为（421±91）m，NT—proBNP为（1262±816）ng／L，肺血管阻力为（1031±582）dyn·s-1·cm-2，CI为（3．5±2．3）L·min-1·m-1，VO2max为（13．8±4．1）ml·min-1·kg-1。相关性分析显示6MWD、肺血管阻力、VO2max与CI相关（r分别为0．299、-0．541、0．341，P〈0．05），而NYHA心功能分级、NT—proBNP与CI不相关。多因素回归分析显示矫正年龄和肺血管阻力后VO2max仍与cI相关（B=0．135，P=0．004），而6MWD与cI不相关。采用ROC曲线分析发现，采用VO2max为15．2ml·min-1·kg“来诊断患者心功能不好的阈值，敏感性为92．6％，特异性为57．5％。结论心肺运动试验测定的VO2max与CI相关性好，在评价肺动脉高压患者右心功能中优于NYHA心功能分级、6MWD和NT—proBNP，V02max低于15．2ml·min-1·kg-1的肺动脉高压患者心功能不好。
Objective To explore the role of peak oxygen consumption in assessment of heart function of patients with pulmonary hypertension. Methods From September 2010 to April 2012, 101 patients [29 male, mean age： （32. 6 ± 11.4 ）years] with pulmonary hypertension diagnosis by right heart catheterization were enrolled. Correlations among peak oxygen consumption, New York Heart Association （NYHA） class, NT-proBNP, 6 minute walking distance （6MWD） and cardiac index are analyzed. Results There were 44 cases with NYHA class II （43.6%）, 49 cases with NYHA class BI （48.5%）, mean 6MWD was （421 ± 91 ）m, NT-proBNP was （1262 ± 816） ng/L, pulmonary vascular resistance was （1031 ± 582） dyn- s-l · cm-5, CIwas （3.5± 2. 3） L·min-1· m-2, peak oxygen consumption was（ 13.8 ± 4. 1 ）ml ~ min-i . kg-i. 6MWD, pulmonary vascular resistance and peak oxygen consumption were related to CI （r = 0. 299, -0. 541,0. 341, respectively, all P 〈 0. 05 ）, but NYHA class and NT-proBNP were not correlated to CI. Multiple regression analysis demonstrated that peak oxygen consumption （ B = 0. 135, P = 0. 004） but not 6MWD was correlated with CI after adjusting age, sex and pulmonary vascular resistance. ROC analysis found that the sensitivity and specificity using peak oxygen consumption 〈 15. 2 ml · min-1 . kg-1 as a cut-off value was 92.6% and 57.5%, respectively, for diagnosing severe heart dysfunction. Conclusions The correlation between peak oxygen consumption and CI is better than that ofNYHA class, 6MWD, and NT-proBNP with CI. Peak oxygen consumption less than 15. 2 ml ·min -· kg-1 could be used to detect reduced CI in patients with pulmonary hypertension.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第6期497-500,共4页
Chinese Journal of Cardiology
关键词
高血压
肺性
心室功能
运动试验
Hypertension, pulmonary
Ventricular function
Exercise test
