诊断学理论与实践

诊断学理论与实践 ›› 2018, Vol. 17 ›› Issue (06): 664-669.doi: 10.16150/j.1671-2870.2018.06.008

• 论著 • 上一篇    下一篇

特发性肺动脉高压患者营养风险与运动耐量间相关性的研究

董芳1, 张益辉1, 郭健2, 刘锦铭2   

  1. 1.同济大学附属上海市第四人民医院（筹）上海市第四人民医院呼吸内科, 上海 200081;
    2.同济大学附属上海市肺科医院肺循环科和肺功能室, 上海 200433
  • 收稿日期:2018-06-28 出版日期:2018-12-25 发布日期:2018-12-25
  • 通讯作者: 刘锦铭 E-mail: jinmingliu2013@126.com
  • 基金资助:
    上海市虹口区卫生和计划生育委员会医学科研课题（虹卫1802-11）

Correlation between nutritional risk and exercise tolerance in patients with idiopathic pulmonary arterial hypertension

DONG Fang1, ZHANG Yihui1, GUO Jian2, LIU Jinming2   

  1. 1. Department of Respiratory Medicine, Shanghai Fourth People's Hospital, Tongji University Shanghai 200081, China;
    2. Department of Pulmonary Circulation and Plumonary Function, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
  • Received:2018-06-28 Online:2018-12-25 Published:2018-12-25

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摘要： 目的：探讨特发性肺动脉高压患者（idiopathic pulmonary arterial hypertension, IPAH）营养风险与运动耐量间的关系。方法：根据营养风险筛查2002标准（Nutritional Risk Screening 2002, NRS-2002）（以下简称NRS）, 对96例IPAH患者进行营养风险评估, 并根据评分结果分为有营养风险组（n=46）及无营养风险组（n=50）, 2组分别进行血气分析、肺功能检测及心肺运动试验,比较2组间的差异。结果：IPAH有营养风险组与无营养风险组间的性别、年龄、身高及血气分析结果差异均无统计学意义（P均>0.05）, 而有营养风险组患者的体重及体质量指数显著低于无营养风险组（P<0.01）。肺功能检测, 有营养风险组的用力肺活量（forced vital capacity, FVC）、第一秒用力呼气容积（forced expiratory volume in one second, FEV1）、FVC占预计值百分比（FVC%pred）、FEV1占预计值百分比（FEV1%pred）、一氧化碳弥散量（diffusing capacity for carbon monoxide, DLCO）、DLCO占预计值百分比（DLCO%pred）均低于无营养风险组（P均<0.05）, 而2组间其他指标[一秒率（FEV1/FVC）、深吸气量、肺总量、残气量、残总比（残气量/肺总量比值）]差异无统计学意义（P均>0.05）。心肺运动试验检查, 有营养风险组的峰值功率、峰值摄氧量、峰值通气量、峰值公斤摄氧量、峰值摄氧量占预计值百分比均低于无营养风险组（P 均<0.05）, 而2组间的峰值氧脉搏差异无统计学意义（P>0.05）。96例IPAH患者的NRS评分与峰值功率、峰值摄氧量呈显著负相关（r=-0.335和-0.342, P均<0.01）, NRS评分与峰值公斤摄氧量呈负相关（r=-0.213, P<0.05）。结论：有营养风险的IPAH患者的肺通气功能及弥散功能降低更显著, 运动耐量下降更明显,而NRS评分可反映其运动耐量。

关键词: 特发性肺动脉高压, 营养风险筛查, 肺功能检测, 心肺运动试验

Abstract: Objective: To explore the correlation between nutritional risk and exercise tolerance in patients with idiopathic pulmonary hypertension (IPAH）. Methods: Nutritional risk was assessed in 96 IPAH patients according to the nutritional risk screening 2002 (NRS-2002). Based on the results of the assessment, they were divided into with nutritional risk group (group A, n=46) and without nutritional risk group (group B, n=50). Arterial blood gas analysis (ABG) was performed in the two groups. The pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) were performed, respectively. Results: ① There were no significant differences in height and age between two groups (P>0.05). The weight and BMI in group A were lower than those in group B. There were no significant differences in blood gas parameters PaO2 and PaCO2 between two groups (P>0.05). ② Pulmonary function tests showed that the FVC, FEV1 in group A were significantly lower than those in group B (P<0.05). The FVC%pred, FEV1%pred, DLCO, DLCO%pred in group A were significantly lower than that in group B (P<0.01). There were no significant differences in other indices (FEV1/FVC, IC, TLC, RV, RV/TLC) between two groups (P>0.05). ③ In cardiopulmonary exercise test, peak VO2%pred, peak load, peak VO2, peak VO2/kg, peak VE in group A were significantly lower than those in group B (P<0.05 or P<0.01). There were no significant differences in peak O2 pulse between the two groups (P>0.05). Of the 96 IPAH patients, the NRS score showed a significant negative correlation with peak VO2 and peak load (r=-0.342 and -0.335, P<0.01), and showed a negative correlation with peak VO2/kg (r=-0.213, P<0.05). Conclusions: The nutritional risk of patients with IPAH can worsen pulmonary ventilation function and diffusion, and decrease exercise tolerance significantly. Nutritional risk assessment may help to understand the severity of patients with IPAH and predict the clinical risk.

Key words: Idiopathic Pulmonary Arterial Hypertension, Nutritional risk screening, Pulmonary function test, Cardiopulmonary exercise test

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