心肺适能对动脉粥样硬化性心血管疾病高危患者的保护作用

目的:在动脉粥样硬化性心血管疾病(arteriosclerotic cardiovascular disease,ASCVD)不同危险程度患者中评估心肺适能对ASCVD事件发生的影响。方法:入选2016年9月至2018年4月期间于北京大学第三医院行心肺运动试验的非ASCVD患者544例,根据《2016年中国成人血脂异常防治指南》对其进行ASCVD总体危险评估,通过心肺运动试验准确测定心肺适能指标——峰值摄氧量(peak oxygen uptake,VO₂peak),并对患者进行临床随访。结果:506例患者完成了随访(低危组250例,中危组93例,高危组163例),中位随访时间为19个月(9~28个月)。在随访期内共51例患者出现ASCVD事件,其中心肌梗死/不稳定心绞痛/冠脉血运重建治疗者 33例,缺血性脑卒中/短暂脑缺血发作/颈动脉血运重建者18例。出现ASCVD事件的患者作为ASCVD组(n=51),其余患者作为非ASCVD组(n=455)。ASCVD组VO₂peak[16.3(3.6)mL/(kg·min) vs. 19.1(3.2)mL/(kg·min), P<0.001]显著低于非ASCVD组。以是否发生ASCVD事件为因变量,进行Logistic回归分析,结果提示VO₂peak[OR 0.893(95% CI:0.831~0.959),P=0.002]及ASCVD危险分层[OR 1.428(95% CI:1.028~1.878),P=0.031]与ASCVD事件的发生独立相关,VO₂peak每升高1 mL/(kg·min),ASCVD事件发生风险降低11%。依据患者VO₂peak的三分位数[14.4 mL/(kg·min), 23.0 mL/(kg·min)]将患者分为低、中、高VO₂peak,分别在ASCVD 危险分层高危和中、低危的患者中,以是否发生ASCVD事件为因变量进行Logistic回归分析。结果显示在ASCVD危险分层高危患者中,中水平VO₂peak[OR 0.210(95% CI:0.054~0.814),P=0.024]及高水平VO₂peak[OR 0.146(95% CI:0.025~0.870), P=0.035]患者ASCVD事件的发生均显著下降,但在ASCVD中低危患者中未发现VO₂peak升高对ASCVD事件发生的显著影响。结论:高心肺适能可显著降低ASCVD高危患者ASCVD事件的发生。

Protective effect of cardiopulmonary fitness on patients with high risk of atherosclerotic cardiovascular disease

Objective: To evaluate the effects of cardiopulmonary fitness on arteriosclerotic cardiovascular disease (ASCVD) events in patients with different risks of ASCVD. Methods: This study enrolled 544 non ASCVD patients who underwent cardiopulmonary exercise testing in Peking University Third Hospital from September 2016 to April 2018. ASCVD overall risk assessment was conducted according to “Chinese Guidelines for the Prevention and Treatment of Adult Dyslipidemia”. Peak oxygen uptake (VO₂peak), the classic indicator of cardiopulmonary fitness, was accurately determined by cardiopulmonary exercise testing in all the patients. All of the patients were followed up clinically. Results: In the study, 506 patients completed the follow-up (250 low-risk patients, 93 moderate-risk patients and 163 high-risk patients). The median follow-up period was 19 months (9-28 months), and 51 patients developed ASCVD events during the follow-up period, of whom, 33 cases developed myocardial infarction, unstable angina or coronary revascularization, and 18 cases ischemic stroke, transient ischemic attack or carotid vascular revascularization. The patients were divided into the ASCVD group (n=51) and the non ASCVD group (n=455) based on the presence or absence of ASCVD events. VO₂peak [16.3(3.6) mL(kg·min) vs. 19.1(3.2) mL/(kg·min), P<0.001] in the ASCVD group were significantly lower than that in the non ASCVD group. Logistic regression analysis found VO2peak [OR 0.893 (95%CI:0.831-0.959), P=0.002] and ASCVD risk stratification [OR 1.428 (95%CI:1.028-1.878), P=0.031] were both independently associated with the occurrence of ASCVD events, which meant that every 1 mL/(kg·min) of increase in VO₂peak, the risk of ASCVD events was reduced by 11%. The patients were divided into low, moderate, and high VO₂peak according to the tertiles of their VO₂peak [14.4 mL/(kg·min), and 23.0 mL/(kg·min)]. Logistic regression analyses were performed using ASCVD events as a dependent variable in the patients with high-risk and low/moderate-risk of ASCVD respectively. In the patients with high-risk of ASCVD, the results suggested that the incidence of ASCVD events was significantly decreased in the patients with moderate VO₂ peak [OR 0.210 (95%CI:0.054-0.814), P=0.024] and high VO₂ peak [OR 0.146 (95%CI:0.025-0.870), P=0.035], but no significant effect of VO₂ peak elevation on the incidence of ASCVD events was found in the low/moderate-risk ASCVD patients. Conclusion: High cardiopulmonary fitness can significantly reduce the occurrence of ASCVD events in patients with high-risk of ASCVD.