心肺运动试验评估冠心病严重程度的价值

目的探讨心肺运动试验（CPET）中的氧摄取动力学、无氧阈及心肺储备功能对冠状动脉狭窄严重程度的评估价值。方法选取68例胸痛患者，根据冠状动脉主要血管的狭窄程度分为〈50％组、50％～75％组、〉75％组。对各组间CPET相关参数（二氧化碳呼吸当量、氧摄取动力学及无氧阈等）进行比较。结果与〈50％组相比，50％～75％组中VO2peak、VCO2、AT、02pulsepeak均明显降低，差异有统计学意义（P〈0．05或0．01），而VT、VENCO厕AT呈下降趋势，但差异无统计学意义（P〉0．05）；〉75％组中除V02peak、VCO2、AT、O2pulsepeak明显降低外（P〈0．05或0．01），HRpeak明显降低、VENC02@AT及VDNT（Est）@peak明显升高，差异均有统计学意义（P〈0．05或0．01）。与50％～75％组比较，〉75％组中仅VDNT（Est）@peak显著升高（P〈0．01）。其他均无明显变化。结论冠状动脉狭窄程度〉50％可能与VO2peak、VCO2、AT、O2pulsepeak有一定的相关性，狭窄程度〉75％可能与HRpeak、VE／VCO2@AT、VDNT（Est）@peak有一定的相关性。

Evaluate the severity of coronary heart disease by cardiopulmonary exercise test

Objective To evaluate the stenosis severity of coronary artery with the kinetics of oxygen uptake （VO2）, anaerobic threshold （AT） and cardiopulmonary functional capacity during exercise tests in patients with suspected angina. Methods Treadmill graded exercise tests with gas analysis, ultrasound cardiography, coronary angiography were conducted in 68 patients with suspected angina. According to stenosis severity of coronary artery, 68 patients were divided into three groups： those with stenosis 〈 50% （n=39）, stenosis 50% - 75% （n=29）, and stenosis 〉 75% （n= 14）. The differences of cardiopulmonary function were evaluated between groups. Results Compared with stenosis 〈 50% group, stenosis 50% N 75% group showed a lower value in VO2peak, VCO2, AT and Q2 pulse peak; stenosis 〉 75% group showed significantly lower VO2peak, VCO2, AT, 02 pulse peak, HR peak（120.50 ± 14.00）vs（139.03 ± 18.97） beats/min,P〈0.01], VENCO2@AT（31.23± 4.89）vs（28.88 ± 4.04）, P〈0.05] and VD/VT（Est） @peak（0.21 ± 0.05）vs（0.17 ± 0.03）,P〈0.01]. Compared with stenosis 50% -75% group, stenosis 〉 75% group showed a significantly lower VD/VT （ Est）@peak. Conclusion CEPT have potential value in evaluating stenosis severity of coronary artery; and HR peak. VE/VCO2@AT and VD/VT（ Est ）@13eak have some correlation with the severity of coronary heart disease.