摘要
目的 探索心房颤动(AF)对冠心病(CHD)患者心肺适能的影响.方法 回顾性研究.收集2013年10月至2023年3月广东省人民医院2 246例冠心病住院患者的临床资料,使用倾向性评分匹配法将患者分为CHD合并AF组(88例)和CHD无AF组(86例).通过心肺运动试验(CPET)测量峰值摄氧量(VO2)和二氧化碳通气当量斜率等反映患者运动能力、心血管功能及肺通气与灌注功能的指标.以峰值VO2作为因变量进行多元线性回归分析,探索AF对CHD患者心肺适能的影响.结果 CHD合并AF组与CHD无AF组体重、体质指数、利尿剂和他汀药物使用、血脂异常、贫血、运动峰值收缩压、糖化血红蛋白、空腹血糖和估算肾小球滤过率、乳酸脱氢酶、肌钙蛋白、B型利钠肽、左心房内径、肺动脉压力、左心室射血分数等比较,差异均有统计学意义(均为P＜0.05).与 CHD 无 AF 组相比,CHD 合并 AF 组峰值 VO2[(15.2±4.6)ml·min-1·kg-1 比(20.7±5.5)ml·min-1·kg-1]、无氧阈[(11.7±6.7)ml·min-1·kg-1 比(16.5±10.1)ml·min-1·kg-1]、峰值负荷功率[(66.6±29.3)W 比(91.0±37.6)W]、峰值氧脉搏[(7.1±3.0)ml/次比(9.9±5.1)ml/次]均降低(均为P＜0.001),运动时二氧化碳通气当量斜率(33.6±8.1比28.4±5.6)、峰值心率[(143.2±31.4)次/min比(128.8±26.4)次/min]均增加(均为P＜0.01).多元线性回归分析显示,合并AF是峰值VO2的独立影响因素(β=-0.419,95％CI:-6.829～-2.932,P＜0.001).结论 CHD合并AF患者会出现心肺适能下降、外周氧摄取减少和通气效率降低.
Abstract
Objective To investigate the effects of atrial fibrillation(AF)on cardiorespiratory fitness in patients with coronary heart disease(CHD).Methods A retrospective study was conducted.Clinical data of 2 246 inpatients with CHD in Guangdong Provincial People's Hospital from October 2013 to March 2023 were collected.The patients were divided into CHD with AF group(88 cases)and CHD without AF group(86 cases)using propensity score matching method.Peak oxygen uptake(peak VO2)and carbon dioxide ventilation equivalent slope were measured by cardiopulmonary exercise testing.A stepwise multiple linear regression analysis with peak VO2 as the dependent variable was performed.Results There were statistically significant differences between the AF and non-AF groups in terms of body weight,body mass index,use of diuretics and statins,dyslipidemia,anemia,peak exercise systolic blood pressure,glycated hemoglobin,fasting blood glucose,estimated glomerular filtration rate,lactate dehydrogenase,troponin,B-type natriuretic peptide,left atrial diameter,pulmonary artery pressure and left ventricular ejection fraction(all P＜0.05).The CHD with AF group had lower values for peak VO2(15.2±4.6 ml·min-1·kg-1 vs.20.7±5.5 ml·min-1·kg-1),anaerobic threshold(11.7±6.7 ml·min-1·kg-1 vs.16.5±10.1 ml·min-1·kg-1),workload at peak exercise(66.6±29.3 W vs.91.0±37.6 W),peak oxygen pulse(7.1±3.0 ml/beat vs.9.9±5.1 ml/beat)(all P＜0.001).The CHD with AF group also showed higher carbon dioxide ventilation equivalent slope(33.6±8.1 vs.28.4±5.6)and peak heart rate(143.2±31.4 beat/min vs.128.8±26.4 beat/min)(both P＜0.01)compared to the non-AF group.Multiple linear regression analysis revealed that AF was an independent factor affecting peak VO2(β=-0.419,95％CI:-6.829 to-2.932,P＜0.001).Conclusions CHD patients with AF may have reduced cardiorespiratory fitness,peripheral oxygen uptake,and ventilatory efficiency.
维普
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