摘要
目的 探究慢性心力衰竭(CHF)患者心肺运动试验参数峰值摄氧量(peak VO_(2))与心率变异指数(HRI)、收缩压恢复比(SBPR)、中部前心房钠尿肽(MR-proANP)的关系。方法 回顾性分析2020年1月至2022年6月首都医科大学附属北京同仁医院收治的79例CHF患者(CHF组)及63例冠心病患者(对照组)。比较不同美国纽约心脏病学会(NYHA)心功能分级CHF组患者及对照组患者peak VO_(2)及HRI、SBPR、MR-pro ANP水平。分析CHF患者peak VO_(2)与HRI、SBPR、MR-pro ANP水平的相关性,以及CHF患者peak VO_(2)、HRI、SBPR、MR-pro ANP水平与NYHA心功能分级的相关性。比较预后较好组及预后不良组CHF患者peak VO_(2)、HRI、SBPR、MR-pro ANP水平。分析peak VO_(2)、HRI、SBPR、MR-pro ANP水平及联合检测评估CHF患者预后的价值。结果 不同NYHA心功能分级CHF组患者peak VO_(2)及HRI均小于对照组患者,SBPR及MR-pro ANP水平均高于对照组患者,且差异均有统计学意义(P<0.05)。NYHA心功能分级Ⅳ级CHF患者peak VO_(2)小于NYHA心功能分级Ⅱ级、Ⅲ级CHF患者,HRI小于NYHA心功能分级Ⅱ级CHF患者,SBPR及MR-pro ANP水平均高于NYHA心功能分级Ⅱ级、Ⅲ级CHF患者,且差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,CHF患者HRI与peak VO_(2)呈正相关(r=0.308,P=0.006);CHF患者SBPR、MR-pro ANP水平与peak VO_(2)呈负相关(r=-0.276,P=0.014;r=-0.319,P=0.004)。Spearman相关分析结果显示,CHF患者peakVO_(2)、HRI与NYHA心功能分级呈负相关(r=-0.313、-0.344,P均<0.001);CHF患者SBPR、MR-pro ANP水平与NYHA心功能分级呈正相关(r=0.353、0.308,P均<0.001)。预后不良组CHF患者peak VO_(2)及HRI均小于预后较好组CHF患者,SBPR及MR-pro ANP水平均高于预后较好组CHF患者,且差异均有统计学意义(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,联合检测peak VO_(2)、HRI、SBPR、MR-pro ANP水平评估CHF预后的曲线下面积(AUC)均大于各指标单独检测,且差异均有统计学意义(P<0.05)。结论 CHF患者心肺运动试验参数peak VO_(2)与HRI、SBPR、MR-pro ANP水平相关,且各指标联合检测对CHF患者预后评估具有一定的价值。
Objective To explore the relationship of cardiopulmonary exercise test parameter peak oxygen consumption(peakVO2) with heart rate variability index(HRI),systolic blood pressure recovery ratio(SBPR) and midregional pro-atrial natriuretic peptide(MR-proANP) in patients with chronic heart failure(CHF).Methods Seventy-nine patients with CHF(CHF group) and 63 patients with coronary heart disease(control group) from January 2020 to June 2022 were enrolled as the study subjects.The peakVO2,HRI,SBPR and MR-proANP were compared among different cardiac function grades and control group,and the correlation between peakVO_(2) and HRI,SBPR and MR-proANP was analyzed.The peakVO_2,HRI,SBPR and MR-proANP were compared between good prognosis group and poor prognosis group,and the evaluated value of each indicators on the prognosis of patients with CHF was analyzed.Results The peakVO_(2) and HRI in patients with CHF of different NYHA cardiac function grades were lower than those in control group,and SBPR was higher than that in control group,and MR-proANP level was also higher than that in control group (P<0.05).The peakVO_(2) in patients with cardiac function gradeⅣwere lower than those in patients with cardiac function gradeⅡorⅢ,and HRI was lower than that in patients with cardiac function gradeⅡ,and SBPR was higher than that in patients with cardiac function gradeⅡorⅢ,and MR-proANP level was higher than that in patients with cardiac function gradeⅡorⅢ(P<0.05).HRI was positively correlated with peakVO_2,and SBPR and MR-proANP were negatively correlated with peakVO_(2) (P<0.05).peakVO_(2) and HRI were negatively correlated with cardiac function grading,and SBPR and MR-proANP were positively correlated with cardiac function grading (P<0.05).peakVO_(2) and HRI of patients with CHF in poor prognosis group were lower than those in good prognosis group while SBPR was higher than that in good prognosis group,and MR-proANP level was higher than that in good prognosis group (P<0.05).The area under the curve (AUC)of combined detection in evaluating the prognosis of CHF was greater than that of peakVO_2,HRI,SBPR or MR-proANP alone(P<0.05).Conclusions Cardiopulmonary exercise test parameter peakVO_(2) is correlated with HRI,SBPR and MR-proANP in patients with CHF,and the combined detection of the above indicators has evaluated value on the prognosis of patients.
作者
李华
曹效
董丹丹
吴昊
LI Hua;CAO Xiao;DONG Dandan;WU Hao(Cardiovascular Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China;Department of Rehabilitation,Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids,Beijing 100176,China)
出处
《中国分子心脏病学杂志》
CAS
2023年第3期5362-5366,共5页
Molecular Cardiology of China
基金
北京市科技计划课题(Z201100002417135)。
关键词
慢性心力衰竭
心肺运动试验
峰值摄氧量
心率变异指数
收缩压恢复比
中部前心房钠尿肽
Chronic heart failure
Cardiopulmonary exercise test
Peak oxygen consumption
Heart rate variability index
Systolic blood pressure recovery ratio
Midregional pro-atrial natriuretic peptide
