特发性肺纤维化患者的通气有效性及运动耐力研究

发布时间：2018-12-10 11:30

【摘要】：目的通过心肺运动试验研究特发性肺纤维化(IPF)对患者通气有效性及其运动耐力的影响。方法对2012年4月至2013年4月确诊为IPF的28例患者(IPF组)和28名年龄、性别匹配的健康志愿者(正常对照组)进行常规肺功能检测、动脉血气分析和心肺运动试验,并测定相关参数。结果两组间年龄[(58±10)比(59±5)岁]、性别、BMI[(23.8±2.7)比(25.0±2.8)]差异均无统计学意义(均P0.05)。IPF组用力肺活量占预计值百分比、第1秒用力呼气容积占预计值百分比、最大分钟通气量占预计值百分比、肺总量占预计值百分比、残气量占预计值百分比、肺CO弥散量占预计值百分比均显著低于正常对照组,分别为(74.8±14.6)%比(101.8±10.8)%、(73.8%±14.6%)比(97.0%±10.1%)、(77.5%±14.9%)比(95.4%±24.5%)、(75.6%±12.4%)比(99.8%±5.4%)、(80.7%±15.4%)比(95.8%±11.3%)、(66.3%±13.7%)比(103.2%±17.3%),均P0.01。IPF组PaO2、SaO2低于正常对照组,分别为(72.7±7.3)mmHg(1 mmHg=0.133 kPa)比(92.6±3.8)mmHg、(94.3%±2.1%)比(98.3%±0.7%),均P0.01,而IPF组的肺泡动脉氧分压差则明显高于正常对照组[(33.3±5.7)mmHg比(17.8±1.9)mmHg,P0.01]。心肺运动试验结果显示,IPF组每分钟通气量与CO2排出量(VE/VCO2)的线性斜率、VE/VCO2最小值均显著高于正常对照组,分别为(37.4±5.3)比(25.7±2.5)、(39.2±6.7)比(30.6±2.7),均P0.01;IPF组4个时期的VE/VCO2和死腔气量与潮气量比均显著高于正常对照组(均P0.01);IPF组峰值运动负荷占预计值百分比、峰值摄氧量占预计值百分比显著低于正常对照组,分别为(70.4%±29.9%)比(104.8%±29.7%)、(68.7%±29.8%)比(98.7%±36.4%),均P0.01。IPF患者无氧阈时的每分钟通气量与C02排出量比值(VE/VCO2@AT)、VE/VCO2线性斜率及VE/VCO2最小值与静息时的肺CO弥散量占预计值百分比呈负相关(分别为r=-0.589,P0.01;r=-0.481,P0.05;r=-0.527,P0.05),其峰值摄氧量占预计值百分比与VE/VCO2@AT、VE/VCO2线性斜率、VE/VCO2最小值呈负相关(分别为r=-0.548,P0.05;r=-0.539,P0.05;r=-0.564,P0.05)。结论特发性肺纤维化使患者的通气有效性明显降低,严重影响患者的运动耐力。
[Abstract]:Objective to study the effect of idiopathic pulmonary fibrosis (IPF) on ventilation effectiveness and exercise endurance by cardiopulmonary exercise test. Methods from April 2012 to April 2013, 28 patients with IPF (IPF group) and 28 healthy volunteers with age and sex matched (normal control group) were examined with routine pulmonary function test, arterial blood gas analysis and cardiopulmonary exercise test. The related parameters were determined. Results there was no significant difference in age [(58 卤10) vs (59 卤5) years], sex, BMI [(23.8 卤2.7) vs (25.0 卤2.8)] between the two groups (P0.05). The percentage of forced expiratory volume to the predicted value, the maximal minute ventilation volume to the predicted value, the total lung volume to the predicted value, the residual air volume to the predicted value, and the lung CO dispersion volume to the predicted value were significantly lower than those of the normal control group. It was (74.8 卤14.6)% vs (101.8 卤10.8)%, (73.8% 卤14.6%) vs (97.0% 卤10.1%), (77.5% 卤14.9%) vs (95.4% 卤24.5%), respectively. (75.6% 卤12.4%) vs (99.8% 卤5.4%), (80.7% 卤15.4%) vs (95.8% 卤11.3%), (66.3% 卤13.7%) vs (103.2% 卤17.3%). SaO2 was (72.7 卤7.3) mmHg (1 mmHg=0.133 kPa) vs (92.6 卤3.8) mmHg, (94.3% 卤2.1%) vs (98.3% 卤0.7%), respectively (P 0.01). The oxygen partial pressure difference of alveolar artery in IPF group was significantly higher than that in normal control group [(33.3 卤5.7) mmHg vs (17.8 卤1.9) mmHg,P0.01]. The results of cardiopulmonary exercise test showed that the linear slope of ventilation volume and CO2 output (VE/VCO2) in IPF group was significantly higher than that in normal control group (37.4 卤5.3) vs (25.7 卤2.5). (39.2 卤6.7) vs (30.6 卤2.7), both P 0.01; The VE/VCO2 and the ratio of dead chamber volume to tidal volume in IPF group were significantly higher than those in normal control group (P0.01). The percentage of peak exercise load and oxygen uptake in the IPF group was significantly lower than that in the normal control group (70.4% 卤29.9% vs 104.8% 卤29.7%, respectively). (68.7% 卤29.8%) vs (98.7% 卤36.4%). The ratio of ventilation volume to CO2 excretion (VE/VCO2@AT) in patients with P0.01.IPF at anaerobic threshold was significant. The linear slope of VE/VCO2 and the minimum value of VE/VCO2 were negatively correlated with the percentage of lung CO dispersion to the predicted value at rest (r = -0.589, P 0.01, respectively). The percentage of peak oxygen uptake in the predicted value was negatively correlated with the linear slope of VE/VCO2@AT,VE/VCO2 and the minimum value of VE/VCO2 (r = -0.548, P 0.05, respectively). (P 0.05). Conclusion Idiopathic pulmonary fibrosis can significantly decrease the ventilation effectiveness and seriously affect the exercise endurance of the patients.
【作者单位】：同济大学附属上海市肺科医院肺功能室;
【分类号】：R563

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