轻-中度慢性阻塞性肺疾病患者左心室功能的变化

目的研究轻-中度慢性阻塞性肺疾病（COPD）患者左心室功能变化情况。方法纳入2009年3月至2010年10月于苏州大学附属第二医院呼吸科门诊就诊的慢性支气管炎患者31例，轻-中度慢性阻塞性肺疾病42例，将16例肺功能正常的中老年体检者作为对照。均检测左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室每搏量（LVsV）和左心室射血分数（LVEF）、心率、心输出量、心脏指数。分析患者左心室功能与肺通气功能指标的相关性。结果健康对照者LVEDV、LVESV、LVSV、心率、心输出量、心脏指数均值分别为（142±10）ml、（50±7）ml、（92±6）ml、（66±5）次／min、（6．0±0．5）L／min和3．7±0．3，与慢性支气管炎患者比较，差异均无统计学意义（P〉0．05）。慢性支气管炎患者LVEDV、LVESV、LVSV、心输出量、心脏指数分别为（137±14）ml、（49±6）ml、（89±9）ml、（6．0±0．5）L／min和3．7±0．4，高于轻-中度COPD患者的（120±16）ml、（44±7）ml、（76±12）ml、（5．5±0．8）L／min和3．3±0．6（P〈0．01），心率比轻一中度COPD患者低，分别为（68±6）次／min与（72±6）次／min（P=0．003）。慢性支气管炎患者与轻-中度COPD患者比较，LVEF均值差异无统计学意义（P=0．130）。在慢性支气管炎和轻．中度COPD患者中，LVEDV、LVESV、LVSV、心输出量、心脏指数与第一秒用力呼气容积、用力肺活量、第一秒用力呼气容积占用力肺活量百分比呈正相关；心率与第一秒用力呼气容积、第一秒用力呼气容积占用力肺活量百分比呈负相关；LVEF与用力肺活量呈正相关，但与第一秒用力呼气容积、第一秒用力呼气容积占用力肺活量百分比无显著相关。LVEDV、LVESV、LVSV、心率、心输出量、心脏指数与第一秒用力呼气容积符合线性关系。结论单纯慢性支气管炎患者左心室功能受损不明显，轻-中度COPD患者已经存在左心室功能减低，主要表现为左心室舒张末期充盈受损。COPD患者气道阻塞程度可以在一定程度上反映出患者左心室功能的受损情况。

Impairment of left ventricular function in patients with mild-to-moderate chronic obstructive pulmonary disease

Objective To determine whether the extent of airflow obstruction is associated with lefi ventrieular function in mild-to-moderate chronic obstructive pulmonary disease （COPD） patients. Methods Left ventricle end diastolic volume （ LVEDV）, left ventricle end systolic volume （ LVESV ）, left ventricle stroke volume（LVSV） , left ventricle ejection fraction（LVEF） , heart rate （HR） , cardiac output （CO） and cardiac index （CI） were measured by ultrasonic cardiogram. Thirty-one patients with chronic bronchitis, 42 mild-to-moderate COPD patients and 16 controls with normal lung function were recruited. The relations between the extent of airflow obstruction and the impairment of left ventricular function were analyzed. Results There were no significant differences of LVEDV, LVESV, LVSV, HR, CO or CI between the control and chronic bronchitis groups. LVEDV, LVESV, LVS~, CO and CI of chronic bronchitis group were significantly higher than those of mild-to-moderate COPD group while HR was lower. LVEDV, LVESV, LVSV, CO and CI had a positive correlation with forced expiratory volume in 1 second （ FEV1 ） , forced vital capacity （FVC） and FEVI/FVC ratio. And HR had a negative correlation with FEV1 and FEV~/FVC. LVEF was positively correlated with FVC, but not with FEV1 and FEVJFVC. LVEDV, LVESV, LVSV, HR, CO and CI were linearly related with FEV1. Conclusions Left ventricular function is maintained in chronic bronchitis patients. Left ventricular function, especially left ventricular end diastolic filling, deteriorates among the mild-to-moderate COPD patients. The extent of airflow obstruction ,nay reflect the impairment of left ventricular function in COPD patients.