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。
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.
[1] Galiè N, Humbert M, Vachiery JL, et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology(AEPC), International Society for Heart and Lung Transplantation (ISHLT)[J]. Eur Heart J,2016,37(1):67-119.
[2] Ling Y, Johnson MK, Kiely DG, et al.Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland[J]. Am J Respir Crit Care Med,2012,186(8):790-796.
[3] Strange G, Lau EM, Giannoulatou E, et al.Survival of Idiopathic Pulmonary Arterial Hypertension Patients in the Modern Era in Australia and New Zealand[J]. Heart Lung Circ,2018,27(11):1368-1375.
[4] Hu EC, He JG, Liu ZH, et al.Survival advantages of excess body mass index in patients with idiopathic pulmonary arterial hypertension[J]. Acta Cardiol,2014,69(6):673-678.
[5] Kondrup J, Allison SP, Elia M, et al.ESPEN guidelines for nutrition screening 2002[J]. Clin Nutr,2003,22(4):415-421.
[6] Velasco C, García E, Rodríguez V, et al.Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study[J]. Eur J Clin Nutr,2011,65(2):269-274.
[7] 刘锦铭, 刘海舰. 心肺运动试验的基本概念及其临床意义[J]. 中华结核和呼吸杂志,2012,35(12):954-956.
[8] 董琳, 何建国, 柳志红, 等. 成人肺动脉高压疾病特征的多中心临床研究[J]. 中华医学杂志,2012.92(16):1087-1090.
[9] 唐志君, 郭健, 杨文兰, 等. 肺动脉高压患者肺功能变化特点研究[J]. 国际呼吸杂志,2014,34(21):1642-1648.
[10] Lewis MI, Belman MJ.Nutrition and the respiratory muscles[J]. Clin Chest Med, 1988,9(2):337-348.
[11] Valli G, Vizza CD, Onorati P, et al.Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension[J]. Eur J Appl Physiol,2008,102(4):417-424.
[12] 陈天翔, 吴粤, 王瑛, 等. 心肺运动试验参数的性别差异对特发性肺动脉高压患者无事件生存率的影响[J]. 同济大学学报(医学版),2018,39(2):66-72.
[13] 陈杨, 杨国玲, 郭健, 等. 心肺运动试验和血流动力学评估特发性肺动脉高压患者预后的作用[J]. 国际呼吸杂志,2017,37(10):752-758.
[14] Wu C, Guo J, Liu H, et al.The Correlation of Decreased Heart Rate Recovery and Chronotropic Incompetence with Exercise Capacity in Idiopathic Pulmonary Arterial Hypertension Patients[J]. Biomed Res Int,2017,2017:3415401.
[15] Gray-Donald K, Gibbons L, Shapiro SH, et al.Nutritional status and mortality in chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med,1996,153(3):961-966.
[16] Sithamparanathan S, Rocha MC, Parikh JD, et al. Skeletal muscle mitochondrial oxidative phosphorylation function in idiopathic pulmonary arterial hypertension: in vivo and in vitro study[J]. Pulm Circ,2018,8(2):20458940 18768290.
[17] Tabima DM, Frizzell S, Gladwin MT.Reactive oxygen and nitrogen species in pulmonary hypertension[J]. Free Radic Biol Med,2012,52(9):1970-1986.
[18] Ross RM.ATS/ACCP statement on cardiopulmonary exercise testing[J]. Am J Respir Crit Care Med,2003,167(10):1451.
