无氧代谢阈值在慢性心力衰竭心功能Ⅰ～Ⅲ级患者定量分级中的作用

摘要

目的：通过对慢性心力衰竭患者无氧代谢阈值（AT）的检测来探讨其在心功能分级中的作用。方法对2007年8月至2013年6月期间入住同济大学附属同济医院心内科的患者进行选择，经心脏超声确定左室射血分数（LVEF）＜0.49的慢性心力衰竭患者129例为慢性心力衰竭组（缺血性心肌病患者74例，扩张型心肌病患者55例；或纽约心脏联合会（NYHA）Ⅰ级5例，Ⅱ级68例，Ⅲ级56例），并实施心肺运动试验（CPET）检测AT，以无氧代谢阈值氧耗量（VO2AT）表示。对照组为129例健康者。结果（1）慢性心力衰竭组VO2AT与对照组差异有统计学意义[（10.5±2.3） vs （15.2±2.7）ml/（kg·min），P＜0.01]。（2）NYHA Ⅰ级、NYHA Ⅱ级、NYHA Ⅲ级慢性心力衰竭患者VO2AT依次减小，差异有统计学意义[（13.4±1.7） vs （10.9±2.3） vs （9.6±2.1）ml/（kg·min）， P＜0.05]。经单因素相关性分析，VO2AT与NYHA呈负相关（r＝-0.732，P＜0.01）。结论 VO2AT与NYHA心功能分级具有相关性，以VO2AT定量评估我国慢性心力衰竭患者心功能具有可能。%ObjectiveTo evaluate the role of anaerobic threshold in the cardiac functional classification for the patients with chronic heart failure (CHF) by cardiopulmonary exercise testing (CPET).Methods Totally 129 patients suffering from CHF with left ventricular ejection fraction (LVEF)<0.49 by echocardiography selected from all the in- and out-patients in Department of Cardiology of our hospital from August 2007 to June 2013 were enrolled in this study. Coronary angiography indicated that there were 74 cases of ischemic cardiomyopathy and 55 cases of dilated cardiomyopathy. Five patients ranked in New York Heart Association classⅠ (NYHAⅠ), 68 patients in NYHAⅡ, and 56 patients in NYHAⅢ. VO2AT were calculated by CPET and then documented. Another 129 age-, gender- and body mass index-matched healthy people taking physical examination in the same period served as control group.Results (1) The difference of VO2AT between CHF patients and controls was statistically significant [(10.5±2.3)vs (15.2±2.7)ml/(kg·min), P<0.01]. (2) The values of VO2AT was gradually decreased among NYHAⅠ, NYHAⅡ and NYHAⅢ with significant differences [(13.4±1.7)vs (10.9±2.3)vs (9.6±2.1)ml/(kg·min),P<0.05]. Univariate analysis indicated that VO2AT was negatively related with NYHA grade (r=-0.732,P<0.01).Conclusion VO2AT is correlated with NYHA grade, and it might be used to evaluate cardiac function for Chinese CHF patients.