冠状动脉临界病变患者心肺运动试验的特点及临床意义

doi:10.3969/j.issn.1006-9771.2022.07.015

Abstract

Abstract:

Objective To review the clinical characteristics and capacity of cardiopulmonary exercise test in patients with intermediate coronary stenosis.

Methods From January, 2015 to January, 2020, the patients underwent coronary angiography and cardiopulmonary exercise test in Beijing Bo'ai Hospital were divided into intermediate coronary stenosis group (n = 184) and non-coronary heart disease group (n = 73). Symptoms, general information, laboratory and echocardiography information, results of cardiopulmonary exercise test were compared between two groups, and the main cardiovascular events during a year were observed.

Results The proportion of male (χ² = 15.857, P < 0.001), smoking history (χ² = 9.067, P= 0.003), hypertension history (χ² = 15.087, P < 0.001) and hyperlipidemia history (χ² = 13.507, P < 0.001) were more, and the level of hemoglobin A1c (Z= 2.431, P= 0.015) and high sensitivity C-reactive protein (Z = 2.108, P = 0.035) were higher in the intermediate coronary stenosis group, while less of them could reach anaerobic threshold (χ² = 10.702, P = 0.001). The heard rate and respiratory exchange rate as anaerobic threshold decreased in the intermediate coronary stenosis group (Z > 2.156, P < 0.05). There was no significant difference in main cardiovascular events between the two groups within a year (P = 1.000).

Conclusion Cardiopulmonary capacity has been impaired in patients with intermediate coronary stenosis, who need to pay attention to the risk factors such as smoking, diabetes mellitus, hypertension and hyperlipidemia.

Key words: intermediate coronary stenosis, cardiopulmonary exercise test, heart rate, oxygen uptake, anaerobic threshold

CLC Number:

R541.4

WANG Guodong,TANG Li,LIU Jie,LIN Wei,ZHANG Yan,ZUO Xuebing. Features of cardiopulmonary exercise test in patients with intermediate coronary stenosis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 833-840.

Figures/Tables 14

References 30

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项目	非冠心病组 (n = 73)	临界病变组 (n = 184)	χ²/t值	P值
性别(男/女)/n	20/53	101/83	15.857	< 0.001
年龄/岁	61.21±7.46	62.94±7.9	1.612	0.108
BMI/kg·m^-2	25.79±3.42	26.41±3.14	1.399	0.163
吸烟史/n	17	80	9.067	0.003
饮酒史/n	12	48	2.719	0.099
高血压史/n	35	135	15.087	< 0.001
糖尿病史/n	16	63	3.727	0.054
高脂血症史/n	37	137	13.507	< 0.001

主诉	非冠心病组 (n = 73)	临界病变组 (n = 184)	χ²值	P值
胸背痛^a	45	101	0.971	0.324
呼吸困难^a	23	68	0.679	0.410
心悸^b	1	4	0	1.000
晕厥^c	1	2		1.000
其他不典型症状^b	3	9	0	1.000

项目	非冠心病组 (n = 73)	临界病变组 (n = 184)	Z/t值	P值
HBA₁C/%	5.9(5.60, 6.36)	6.2(5.73, 7.05)	2.431	0.015
LDL-C/mmol·L^-1	2.48(1.96, 3.18)	2.42(1.99, 3.21)	0.223	0.823
WBC/10⁹·L^-1	6.13±1.57	6.26±1.67	0.568	0.571
hsCRP/mg·dL^-1	0.1(0.04, 0.24)	0.16(0.06, 0.39)	2.108	0.035
EF/%	66(62, 70)	65.1(62, 69)	0.914	0.361

项目	非冠心病组 (n = 73)		χ²值	P值
终止原因			0.000	0.989
ST改变	56	141
其他	17	43
强度达到无氧阈	69	142	10.702	0.001
结果			0.939	0.332
阳性	38	108
阴性	35	76

项目	非冠心病组(n = 73)	临界病变组(n = 184)	t/Z值	P值
静息心率/min^-1	70(64.5, 75)	68(63, 74)	1.233	0.218
峰值心率/min^-1	123.6±18.3	117.1±17.1	2.705	0.007
峰值心率/%pred	77(69, 85)	73(67, 81)	2.087	0.037
无氧阈心率/min^-1	99(89.5, 106.5)	92.5(71, 102)	3.283	0.001
峰值功率/W	88.2±24.2	89.2±35.2	0.208	0.835
最大通气量/L	40(33.5, 49)	41(32, 53)	0.351	0.726
无氧阈摄氧量/ml·min^-1	789(622.7, 905)	778.5(481, 986.3)	0.359	0.719
VO_2max/ml·min^-1	1148(996, 1325.5)	1159(920.5, 1433)	0.315	0.752
单位体质量VO_2peak/ml·min^-1·kg^-1	17.49±3.6	16.8±4.4	1.170	0.243
无氧阈单位体质量摄氧量/ml·min^-1·kg^-1	11.4(9.3, 13.9)	11.05(6.95, 13.5)	1.659	0.097
VO_2peak/%pred	79(69.5, 89)	70.5(62, 82)	3.147	0.002
峰值CO₂排出量/ml·min^-1	1289.2±351.2	1297.5±470.3	0.136	0.892
无氧阈CO₂通气当量	29.5(27.05, 32.1)	28.9(24.4, 31.95)	1.781	0.075
峰值RER	1.1(1.03, 1.17)	1.09(1.01, 1.16)	0.919	0.358
无氧阈RER	0.9(0.86, 0.98)	0.89(0.78, 0.96)	2.156	0.031
METs	5.01±1.02	4.82±1.22	1.181	0.239

Features of cardiopulmonary exercise test in patients with intermediate coronary stenosis

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变量	B	SE	β	P值
常量	135.149	6.764		< 0.001
性别	-3.875	3.251	-0.106	0.234
高血压史	-1.577	2.555	-0.041	0.538
高脂血症史	-5.647	2.576	-0.145	0.029
吸烟史	-5.150	3.298	-0.137	0.120
冠脉造影结果	-2.194	1.332	-0.108	0.101

变量	B	SE	β	P值
常量	86.732	4.159		< 0.001
性别	-3.813	1.999	-0.169	0.058
高血压史	0.084	1.571	0.004	0.957
吸烟史	-5.303	2.028	-0.229	0.009
高脂血症史冠脉造影结果	-3.590 -0.878	1.584 0.819	-0.149 -0.070	0.024 0.285

变量	B	SE	β	P值
常量	117.406	14.808		< 0.001
性别	-11.342	7.116	-0.141	0.112
高血压史	7.154	5.593	0.084	0.202
高脂血症史	-10.642	5.639	-0.124	0.060
吸烟史	-6.188	7.220	-0.074	0.392
冠脉造影结果	-9.944	2.915	-0.223	0.001

变量	B	SE	β	P值
常量	-1738.467	515.878		0.001
性别	-105.934	57.159	-0.160	0.065
身高	1920.663	279.456	0.490	< 0.001
高血压史	48.274	37.477	0.069	0.199
吸烟史	3.734	48.494	0.005	0.939
高脂血症史冠脉造影结果	-69.397 -20.160	37.760 19.551	-0.098 -0.055	0.067 0.303

变量	B	SE	β	P值
常量	72.668	28.847		0.012
性别	8.818	3.196	0.279	0.006
身高	-5.070	15.626	-0.027	0.746
高血压史	1.883	2.096	0.056	0.370
吸烟史	-2.170	2.712	-0.067	0.424
高脂血症史冠脉造影结果	-1.823 -1.769	2.111 1.093	-0.054 -0.101	0.389 0.107

变量	B	SE	β	P值
常量	-2506.941	710.703		< 0.001
性别	-14.673	78.745	-0.018	0.852
身高	2035.722	384.995	0.431	< 0.001
高血压史	91.692	51.631	0.109	0.077
吸烟史	-40.703	66.809	-0.050	0.543
高脂血症史冠脉造影结果	-80.888 -59.954	52.020 26.934	-0.095 -0.136	0.121 0.027

变量	B	SE	β	P值
常量	0.676	0.210		0.001
性别	-0.004	0.023	-0.018	0.864
身高	0.273	0.114	0.212	0.017
高血压史	-0.003	0.015	-0.012	0.857
吸烟史	-0.007	0.020	-0.032	0.718
高脂血症史冠脉造影结果	-0.019 -0.010	0.015 0.008	-0.083 -0.080	0.209 0.226

变量	B	SE	β	P值
常量	-0.779	0.685		0.257
性别	-0.003	0.076	-0.004	0.967
身高	1.043	0.371	0.242	0.005
高血压史	0.063	0.050	0.082	0.205
吸烟史	-0.059	0.064	-0.078	0.364
高脂血症史冠脉造影结果	-0.075 -0.090	0.050 0.026	-0.096 -0.224	0.139 0.001

变量	B	SE	β	P值
常量	13.543	0.922		< 0.001
年龄	-0.061	0.008	-0.411	< 0.001
性别	-1.231	0.187	-0.527	< 0.001
体质量	-0.039	0.006	-0.369	< 0.001
高血压史	0.121	0.142	0.049	0.396
吸烟史	-0.157	0.183	-0.065	0.392
高脂血症史冠脉造影结果	-0.123 -0.124	0.142 0.073	-0.049 -0.096	0.387 0.092

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