二尖瓣关闭不全患者的运动病理生理学特征的临床研究报告

doi:10.12047/j.cjap.0105.2021.119

中国应用生理学杂志 ›› 2021, Vol. 37 ›› Issue (2): 154-161.doi: 10.12047/j.cjap.0105.2021.119

二尖瓣关闭不全患者的运动病理生理学特征的临床研究报告

穆希娅^1,2,3, 孙兴国^1,2△, 台文琦², 王继楠^2,4, 周晴晴^2,4, 张艳芳^2,4, 宋雅^2,4, 石超², 徐凡², 徐丹丹⁵, 孙淑艳^1,3△

1.内蒙古科技大学包头医学院研究生院,包头 014000;
2.国家心血管病中心,中国医学科学院阜外医院,北京协和医学院心血管疾病国家重点实验室,心血管疾病国家临床医学研究中心,北京协和医学院心血管疾病国家重点实验室,心血管疾病国家临床医学研究中心,北京100037;
3.内蒙古科技大学包头医学院第一附属医院,包头014010;
4.重庆医科大学附属康复医院,重庆400050;
5.湖北省中医院,武汉 430061

收稿日期:2020-08-12 修回日期:2021-01-07 出版日期:2021-03-28 发布日期:2021-10-20
通讯作者: ^△Tel：010-88398300;E-mail: xgsun@lundquist.org
基金资助:
^*国家高技术研究发展计划（863计划）课题资助项目（2012AA021009）; 国家自然科学基金医学科学部面上项目（81470204）; 中国康复医疗机构联合重大项目基金（20160102）; 中国医学科学院国家心血管病中心阜外医院科研开发启动基金（2012-YJR02）; 首都临床特色应用研究与成果推广（Z161100000516127）; 北京康复医院2019-2021科技发展专项（2019-003）; 北京协和医学院教学改革项目（2018E-JG07）; 北京协和医学院-国家外国专家局外国专家项目（2015,2016,T2017025,T2018046,G2019001660）; 重庆市卫计委医学科研计划项目（2017MSXM090）; 重庆市科委社会事业与民生保障科技创新专项项目（cstc2017shmsA130063）

A clinical research report on the pathophysiological characteristics of exercise in patients with mitral regurgitation

Mu xiya^1,2,3, SUN Xing-guo^1,2△, TAI Wen-qi², WANG Ji-nan^2,4, ZHOU Qing-qing^2,4, ZHANG Yan-fang^2,4, SONG Ya^3,4, SHI Chao², XU Fan², XU Dan-dan⁵, SUN Shu-yan^1,3△

1. Graduate School of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014000;
2. National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, State Key Laboratory of Cardiovascular Diseases, Peking Union Medical College, National Clinical Medical Research Center for Cardiovascular Diseases, Peking Union Medical College State Key Laboratory of Cardiovascular Diseases, School of Medicine, National Clinical Medical Research Center for Cardiovascular Diseases, Beijing 100037;
3. Department of Cardiology, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010;
4. Rehabilitation Hospital of Chongqing Medical University , Chongqing 400050;
5. Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430061, China

Received:2020-08-12 Revised:2021-01-07 Online:2021-03-28 Published:2021-10-20

摘要/Abstract

摘要： 目的: 通过心肺运动试验（CPET）进行二尖瓣关闭不全的运动病理生理学特征的相关研究。方法: 自2016年以来签署知情同意后,严格质控下完成规范化CPET极限运动的中重度二尖瓣关闭不全患者26例,取同期正常人11例为对照组。将CPET核心指标按照标准方法分析计算,并与正常人比较,进行组间统计学独立样本t检验。同时将患者是否存在心衰和波浪式呼吸（OB）分别分为两个亚组;其中无心衰11例,心衰15例;非OB 8例,OB18例,并分别对各亚组间比较其异同。结果: 正常人峰值摄氧量（85.60± 9.06）%pred及无氧阈（87.59 ±15.38）%pred等CPET核心指标均为正常范围。二尖瓣关闭不全患者CPET的峰值摄氧量为（48.15 ±12.11）%pred、峰值氧脉搏（66.57±12.20）%pred 、无氧阈（56.75 ±11.50）%pred、摄氧通气效率峰值平台（OUEP）（88.24 ±16.42）%pred、二氧化碳排出通气效率最低值（125.89 ±27.05）%pred和二氧化碳排出通气斜率（128.31 ±31.68）%pred,其中仅摄氧通气效率峰值平台属于正常偏低,其余指标均为显著异常;且与对照组均存在显著差异（P<0.01）。无心力衰竭组与心力衰竭组组间比较均无差异（P>0.05）,但所有指标均与对照组有显著差异（P<0.05）;非OB组与OB组组间比较均无差异（P>0.05）,但均与对照组有显著差异（P<0.05）。结论: 二尖瓣关闭不全病人除摄氧通气有效性正常偏低外,所有心肺运动核心指标均显著异常。且有无心衰和OB均未影响其心肺运动功能状态。

关键词: 瓣膜病, 二尖瓣关闭不全, 心肺运动试验, 病理生理

Abstract: Objective: Cardiopulmonary exercise testing (CPET) was used to investigate the exercise pathophysiology of mitral regurgitation. Methods: 26 patients with moderate and severe mitral regurgitation who completed standardized extreme exercise CPET under strict quality control after signing informed consent since 2016, and 11 normal subjects in the same period as the control group. The core indexes of CPET were analyzed and calculated according to the standard method and compared with normal subjects for intergroup statistical independent sample t-test. At the same time, the patients with heart failure and exercise oscillation breathing (OB) were divided into two subgroups: 11 cases without heart failure, 15 cases with heart failure, 8 cases with non-OB and 18 cases with OB, and their similarities and differences were compared between each subgroup. Results: The core indexes of CPET, such as peak oxygen uptake (85.60 ±9.06)%pred and anaerobic threshold (AT, (87.59 ±15.38)%pred) were normal. The peak oxygen uptake of CPET in patients with mitral regurgitation was (48.15 ±12.11)%pred, peak oxygen pulse was (66.57 ±12.20)%pred, AT was (56.75 ±11.50)%pred, oxygen uptake efficiency plateau was (88.24 ±16.42)%pred , lowest value of carbon dioxide ventilatory efficiency was (125.89 ±27.05)%pred and slope of carbon dioxide ventilatory efficiency was (128.31 ±31.68)%pred. Among them, only oxygen uptake efficiency plateau (OUEP) was normal and low, and the other indexes were significantly abnormal. There were significant differences between the patients and the control group (P<0.01). There was no significant difference between the non-OB group and the OB group, but there was significant difference between the non-OB group and the control group (P<0.05). There was no significant difference between the non-heart failure group and the heart failure group, but there was significant difference between the non-heart failure group and the control group. Conclusion: All the core indexes of cardiopulmonary exercise are significantly abnormal in patients with mitral regurgitation who are significantly lower than those in normal subjects except for the low effectiveness of oxygen ventilation. And with or without heart failure and OB did not affect the cardiopulmonary function.

Key words: valvular heart disease, mitral regurgitation, cardopulmonary exercise testing, pathophysiology

中图分类号:

R542.5

穆希娅, 孙兴国, 台文琦, 王继楠, 周晴晴, 张艳芳, 宋雅, 石超, 徐凡, 徐丹丹, 孙淑艳. 二尖瓣关闭不全患者的运动病理生理学特征的临床研究报告[J]. 中国应用生理学杂志, 2021, 37(2): 154-161.

Mu xiya, SUN Xing-guo, TAI Wen-qi, WANG Ji-nan, ZHOU Qing-qing, ZHANG Yan-fang, SONG Ya, SHI Chao, XU Fan, XU Dan-dan, SUN Shu-yan. A clinical research report on the pathophysiological characteristics of exercise in patients with mitral regurgitation[J]. CJAP, 2021, 37(2): 154-161.

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二尖瓣关闭不全患者的运动病理生理学特征的临床研究报告

A clinical research report on the pathophysiological characteristics of exercise in patients with mitral regurgitation

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