峰值循环泵功能预测特发性肺动脉高压预后

摘要

Objective To assess the prognostic value of peak circulatory power(peak CircP) on long-term outcomes in patients with idiopathic pulmonary arterial hypertension(IPAH). Methods Patients with newly diagnosed IPAH who underwent symptom-limited cardiopulmonary exercise testing(CPET)from 1 January 2011 to 1 January 2014 in Fuwai hospital were prospectively enrolled ,patients were followed for up to 66 months for major cardiac events(mortality and lung transplantation). Prognostic value was assessed by survival curves(Kaplan-Meier method)and uni- and multivariate Cox analyses. Results One hundred and forty patients with newly diagnosed IPAH ( total 140 patients,103 female, mean age 33 ± 11years) were studied. Follow-up results(mean 42 ± 14 months):24 (17. 1% ) patients died of right heart failure and 1 (0. 7% )patient underwent lung transplantation. In a univariate analysis,peak oxygen uptake,oxygen uptake at anaerobic threshold,ventilation/ carbon dioxide output slope(VE/ VCO2 slope),end tidal partial pressure of carbon dioxide at anaerobic threshold( PETCO2 @ AT),peak systolic blood pressure( SBP),ΔSBP,ΔHR, peak work rate,peak CircP,pulmonary vascular resistance,cardiac index,WHO functional class were all predictive of cardiac events ( all P < 0. 05) . After adjustment for age, gender and body mass index , multivariate analysis demonstrated that peak CircP was the strongest independent predictor of outcome among exercise parameters(chi-square = 9. 95,P < 0. 002,RR:0. 99,95% CI:0. 99-0. 99 ). Conclusions Peak CircP,better than peak VO2 and VE/ VCO2 slope,can better predict the prognosis of idiopathic pulmonary hypertension.%目的 探讨峰值循环泵功能对特发性肺动脉高压患者预后的预测价值.方法 前瞻性连续入组2011年1月至2014年1月阜外医院新诊断的特发性肺动脉高压患者,定期随访患者主要心血管事件(死亡或肺移植),最长随访66个月[平均(42±14)个月].采用Kaplan-Meier曲线,单因素和多因素Cox比例风险回归模型进行生存分析.结果 140例新诊断的特发性肺动脉高压患者完成了心肺运动试验(女性103例,平均年龄33±11岁),随访结果:24例(17.1%)患者死于右心衰竭,1例(0.7%)患者进行肺移植.单因素分析表明:峰值摄氧量、无氧阈、分钟通气量与二氧化碳排出量比值、呼气末二氧化碳分压、峰值功率、峰值收缩压、收缩压变化值、心率变化值、峰值循环泵功能、肺血管阻力、心指数、WHO心功能分级均能预测特发性肺动脉高压患者预后(均为P<0.05).在校正年龄、性别和体重指数后,多因素Cox分析结果表明:峰值循环泵功能是唯一可以独立预测特发性肺动脉高压患者预后的指标(χ2=9.95,P<0.002,RR:0.99,95%CI:0.99~0.99).结论 峰值循环泵功能,优于峰值摄氧量和通气效率,可以更好地预测特发肺动脉高压的预后.