肥厚型心肌病患者在心肺运动中核心指标的特征性研究*

doi:10.12047/j.cjap.0095.2021.107

中国应用生理学杂志 ›› 2021, Vol. 37 ›› Issue (1): 65-71.doi: 10.12047/j.cjap.0095.2021.107

肥厚型心肌病患者在心肺运动中核心指标的特征性研究^*

陈颖哲^1,2, 孙兴国, 台文琦¹, 宋雅^1,3, 石超¹, 郝璐^1,3, 王继楠^1,3, 胡小莹¹, 张也¹, 刘方¹

1.中国医学科学院北京协和医院国家心血管中心阜外医院心血管疾病国家重点实验室,心血管疾病国家临床医学中心,北京 100037;
2.首都医科大学附属北京中医医院,北京 100010;
3.重庆医科大学附属康复医院,重庆 400050

收稿日期:2020-08-12 修回日期:2021-01-11 发布日期:2021-10-21
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）

The characteristics of core parameters during cardiopulmonary exercise testing in patients with hypertrophy cardiomyopathy

CHEN Ying-zhe^1,2, SUN Xing-guo, TAI Wen-qi¹, SONG Ya^1,3, SHI Chao¹, HAO Lu^1,3, WANG Ji-nan^1,3, HU Xiao-ying¹, ZHANG Ye¹, LIU Fang¹

1. National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Pebing Union Medical College, National Center for Cardiovascular Disease, Key Laboratory of Cardiovascular Diseases, Beijing 100037;
2. Beijing Hospital of Traditional Chinese Medicine Capital Medical University, Beijing 100037;
3. The Affiliated Rehabititation of Hospital of Chongqing Medical University, Chongqing 400050, China

Received:2020-08-12 Revised:2021-01-11 Published:2021-10-21

摘要/Abstract

摘要： 目的: 肥厚型心肌病（HCM）,以心肌肥厚为主要特征的心肌疾病,猝死率高。临床症状表现为呼吸困难、乏力、胸痛等。症状限制性极限运动心肺运动试验（CPET）在整体整合生理和医学（HIPM）理论指导下是唯一评估人体整体功能状态检查,肥厚型心肌病患者在心肺运动中核心数据变化值得进一步探讨。方法: 选择2017年4月至2020年1月在阜外医院就诊签署知情同意书后完成CPET受试者244例为研究对象,其中219例肥厚型心肌病（肥厚心组）和无诊断疾病健康人25例（正常组）,观察两组CPET核心指标的异同。结果: ①肥厚心组男163女56例,正常组11男14女;肥厚心组年龄（46.7±12.8,16.0~71.0）岁;正常组年龄（43.7±10.4,26.0~61.0）岁。②肥厚心组CPET核心指标的峰值摄氧量（Peak VO₂）为（65.2±13.8,22.8~103.4）%pred;无氧阈（AT）为（66.4±13.0,33.7~103.5）%pred;峰值氧脉搏（Peak O₂pulse）为（84.3±19.0,90.9~126.0）%pred;摄氧效率平台（OUEP）为（99.2±13.4,69.1~155.5）%pred;分钟通气量和二氧化碳排出量比值最小值（Lowest VE/VCO₂）为（108.0±13.2,70.4~154.0）%pred;分钟通气量和二氧化碳排出量比值斜率（VE/VCO₂Slope）为（108.5±17.9,66.9~164.9）%pred, 肥厚心组较正常组在峰值摄氧量,无氧阈,峰值氧脉搏,摄氧效率平台等百分预计值（%pred）等指标均显著降低（P<0.01或P<0.05）;而Lowest VE/VCO₂和VE/VCO₂Slope（%pred）显著升高（P<0.05）,差异均有统计学意义。个体而言,部分患者就诊时整体功能状态尚在正常范围内。③CPET中Peak VO₂与其他核心指标AT、OUEP、Peak O₂pulse、峰值收缩压呈正相关;与Lowest VE/VCO₂ 和VE/VCO₂Slope呈负相关。结论: 肥厚型心肌病患者能安全完成CPET,CPET指标具有特异性,不仅可用于整体功能评测、疾病诊断与鉴别诊断、危险分层、疗效评估和精准预后预测,并可用于整体论指导下的个体化整体方案慢病有效管理,值得进一步深入研究和临床推广应用。

关键词: 肥厚型心肌病, 症状限制性极限心肺运动试验, 整体整合生理学医学, 运动病理生理学, 整体功能受限

Abstract: Objective: The patients with Hypertrophic CardioMyopathy (HCM), characterized by hypertrophy of the myocardium with a high risk of sudden death, was less clear for the exercise pathophysiology. Under the guidance of holistic integrative physiology and medicine (HIPM), the ramp protocol symptom-limited CardioPulmonary Exercise Testing (CPET) is the only method to evaluate the overall functional status of human body. We investigated the CPET pathophysiology in patients with HCM. Methods: From April 2017 to January 2020, 244 subjects were enrolled after signed the informed consent form and completing CPET in Fuwai Hospital. They 219 HCM patients and 25 healthy normal subjects as control (NS). The changes of CPET core parameters between two them were calculated, compared and did Individual analysis. Results: ①The gender of HCM was 163 maleand 56 female. The gender of NS was 11 male and 14 female. The age of HCM was (46.7±12.8, 16.0~71.0) year; NS was (43.7±10.4, 26.0~61.0) year.②The core CPET parameters of HCM: peak oxygen uptake (Peak VO₂) was (65.2±13.8, 22.8~103.4) %pred; anaerobic threshold (AT) was (66.4±13.0, 33.7~103.5) %pred; Peak O₂ pulse was (84.3±19.0, 90.9~126.0)%pred; oxygen uptake efficiency platform (OUEP) was (99.2±13.4, 69.1~155.5) %pred; Lowest VE/VCO₂ was (108.0±13.2, 70.4~154.0)%pred; VE/VCO₂ Slope was (108.5±17.9, 66.9~164.9)%pred. Compared with NS, the Peak VO₂, AT, Peak O₂ pulse, and OUEP were significantly decreased (P<0.01 or P<0.05), but the Lowest VE/VCO₂ and VE/VCO₂ Slope were significantly increased (P<0.05). For Individual analysis of the overall functional status of CPET, some were very sever but some HCM were still within the normal range.③ The Peak VO₂ was positively correlated with AT, OUEP, Peak O₂pulse, and peak systolic blood pressure, but was negative correlated with Lowest VE/VCO₂ and VE/VCO₂ Slope. Conclusion: CPET is safe and specific characteristics for patients with HCM, which deserve further research and clinical application. Under HIPM guidance, CPET can not only be used for overall functional evaluation, disease diagnosis and differential diagnosis, risk stratification, curative effect evaluation and accurate prognostic prediction, but also be utilized in formulating the individualized training prescription and management of chronic diseases.

Key words: hypertrophic cardiomyopathy, symptom-restricted cardiopulmonary exercise testing, holistic integrative physiology and medicine, sports pathophysiology, overall function is limited

中图分类号:

陈颖哲, 孙兴国, 台文琦, 宋雅, 石超, 郝璐, 王继楠, 胡小莹, 张也, 刘方. 肥厚型心肌病患者在心肺运动中核心指标的特征性研究^*[J]. 中国应用生理学杂志, 2021, 37(1): 65-71.

CHEN Ying-zhe, SUN Xing-guo, TAI Wen-qi, SONG Ya, SHI Chao, HAO Lu, WANG Ji-nan, HU Xiao-ying, ZHANG Ye, LIU Fang. The characteristics of core parameters during cardiopulmonary exercise testing in patients with hypertrophy cardiomyopathy[J]. CJAP, 2021, 37(1): 65-71.

参考文献

[1] Magrì D, Santilamazza C.Cardiopulmonary exercise test in hypertrophic cardiomyopathy[J]. Ann Am Thorac Soc, 2017, 14(Suppl 1): S102-S109.
[2] Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(39): 2733-2779.
[3] Olivotto I, Maron BJ, Montereggi A, et al. Prognostic value of systemic blood pressure response during exercise in a community- based patient population with hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 1999, 33(7): 2044-2051.
[4] Wasserman K, Hansen JE, Sue DY, et al. Principles of exercise testing and interpretation-Including pathophysiology and clinical applications[M]. 5th ed, Philadelphia: LIPPINCOTT WILLIAMS & WILKINS, 2012.
[5] Wasserman K, Stringer WW, Sun XG, et al.Cardiopulmonary exercise testing and cardiovascular health[M]. Armonk, NY: Futura Publishing Company; 2002: 2-25.
[6] Whipp BJ, William SA.Cardiopulmonary coupling during exercise[J]. J Exp Biol, 1982, 100: 175-193.
[7] Wasserman K, Van Kessel A, Burton GG.Interaction of Physiological mechanisms during exercise[J]. J Appl Physiol, 1967, 22: 71-85.
[8] 谭晓越, 孙兴国. 从心肺运动的应用价值看医学整体整合的需求[J]. 医学与哲学, 2013, 43(3): 28-31.
[9] Sun XG, Hansen JE, Beshai JF, et al. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure.[J]. J Am Coll Cardiol, 2010, 55(17): 1814-1823.
[10] Rovai S, Corrà U, Piepoli M, et al. Exercise oscillatory ventilation and prognosis in heart failure patients with reduced and mid-range ejection fraction[J]. Eur J Heart Fail, 2019, 21(12): 1586-1595.
[11] SunXG,HansenJE,StringerWW. Oxygen uptake efficiency plateau best predicts early death in heart failure[J]. Chest, 2012, 141(5): 1284-1294.
[12] Sun XG, Hansen JE, Qudiz RJ.Pulmonary function in primary pulmonary hypertension patients[J]. J Am Coll Cardiol, 2003, 41: 1028-1035.
[13] Sun XG, Hansen JE, Qudiz RJ.Exercise pathophysiology in patients with primary pulmonary hypertension[J]. Circulation, 2001, 104(4): 429-435.
[14] Mehra MR, Canter CE, Hannana MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update[J]. J Heart Lung Transplant, 2016, 35(1): 1-23.
[15] Guazzi M, Arena R, Halle M, et al. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations[J]. Circulation, 2012, 33(23): 2261-2274.
[16] Coats CJ, Rantell K, Bartnik A, et al. Cardiopulmonary exercise testing and prognosis in hypertrophic cardiomyopathy[J]. Circ Heart Fail, 2015, 8(6): 1022-1031.
[17] 中国医师协会心力衰竭专业委员会, 中华心力衰竭和心肌病杂志编辑委员会. 中国肥厚型心肌病管理指南2017[J]. 中华心力衰竭和心肌病杂志, 2017, 1(2): 65-86.
[18] Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2011, 124(24): 785-831.
[19] American Thoracic Society,American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing[J]. Am J Respir Crit Care Med, 2003, 167(2): 211-277.
[20] 孙兴国. 更为强化心肺代谢等整体功能的心肺运动试验新 9 图图解[J].中国应用生理学杂志, 2015, 31(4): 369-373.
[21] 孙兴国. 心肺运动试验的规范化操作要求和难点 - 数据分析图示与判读原则[J].中国应用生理学杂志, 2015, 31(4): 361-365.
[22] 费家玥,孙兴国,于辉,等.功率递增速率影响正常人心肺运动试验峰值呼吸交换率的初步观察研究[J].中国全科医学, 2018, 21(30): 3687-3692.
[23] Magri D, Re F, Limongelli G, et al. Heart failure progression in hypertrophic cardiomyopathy - possible insights from cardiopulmonary exercise testing[J]. Circ J, 2016, 80: 2204-2211.
[24] Masri A, Pierson LM, Smedira NG, et al. Predictors of long-term outcomes in patients with hypertrophic cardiomyopathy undergoing cardiopulmonary stress testing and echocardiography[J]. Am Heart J, 2015, 169: 684-692.
[25] Coats CJ, Rantell K, Bartnik A, et al. Cardiopulmonary exercise testing and prognosis in hypertrophic cardiomyopathy[J]. Circ Heart Fail, 2015, 8: 1022-1031.
[26] Magri D, Limongelli G, Re F, et al. Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy[J]. Heart, 2016, 102(8): 602-609.
[27] Magri D, Corra U, Di Lenarda, et al. Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut-off criteria[J]. Eur J Heart Fail, 2014, 16(2): 201-209.
[28] 郝湛军, 张延斌. 运动试验对心尖肥厚型心肌病患者心电图的影响[J].徐州医学院学报, 2020, 20(6): 457-459.

肥厚型心肌病患者在心肺运动中核心指标的特征性研究^*

The characteristics of core parameters during cardiopulmonary exercise testing in patients with hypertrophy cardiomyopathy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 6

编辑推荐

Metrics

本文评价

[1]	王继楠, 孙兴国, 谢友红, 宋雅, 台文琦, 周晴晴, 张艳芳, 石超, 徐凡, 刘方, 张也, 郝璐, 葛万刚, 李浩, 徐丹丹. 正常人和无睡眠呼吸异常慢病患者睡眠期间的呼吸源性心率变异初步报告^*[J]. 中国应用生理学杂志, 2021, 37(2): 125-134.
[2]	周晴晴, 孙兴国, 王继楠, 台文琦, 宋雅, 郝璐, 张也, 葛万刚, 李浩, 张艳芳, 石超, 徐凡, 徐丹丹, 谢友红. 存在睡眠呼吸异常的慢病患者呼吸影响心率变异性的初步分析^*[J]. 中国应用生理学杂志, 2021, 37(2): 135-141.
[3]	李慧敏, 孙兴国, 台文琦, 宋雅, 郝璐, 张也, 刘方, 王继楠, 周晴晴, 徐丹丹, 徐凡, 石超. 新理论CPET指导个体化精准运动整体方案有效改善“虚弱症”的整体功能状态^*[J]. 中国应用生理学杂志, 2021, 37(2): 208-218.
[4]	胡小莹, 孙兴国, 乔树宾, 高晓津, 罗晓亮, 刘方, 张也, 郝璐, 宋雅, 陈颖哲, 王继楠, 台文琦, 石超, 徐凡, 翟文轩, 杨洁, 张天静. 肥厚型心肌病患者运动血压反应异常的两类表现及其相关因素分析^*[J]. 中国应用生理学杂志, 2021, 37(1): 27-33.
[5]	王桂芝, 孙兴国, 陈荣声, 杨希营, 赵晓勇, 于剑锋, 张蕊, 冀玉萍, 李军, 李浩, 张也, 马铭欣, 陈荣, 邹昱馨. 正常分钟通气量机械通气不同潮气量和频率影响活体山羊颈动脉血氧动态变化的初步实验研究^*[J]. 中国应用生理学杂志, 2021, 37(1): 45-50.
[6]	孙兴国, 陈荣声, 王桂芝, 杨希营, 赵晓勇, 于剑锋, 张蕊, 冀玉萍, 李军, 李浩, 张也, 马铭欣, 陈荣, 邹昱馨. 超快速反应聚合物光纤氧测定装置及其用于活体动物机械通气下动脉血氧分压连续动态变化的初步实验报告^*[J]. 中国应用生理学杂志, 2021, 37(1): 104-112.