心肺运动试验参数预测特发性肺动脉高压患者肺血管阻力升高的性别差异

目的 研究特发性肺动脉高压（idiopathic pulmonary arterial hypertension, IPAH）患者的心肺运动试验（cardiopulmonary exercise testing, CPET）参数的性别差异，并探究CPET参数中预测肺血管阻力（pulmonary vascular resistance, PVR）升高的独立预测因子及性别差异。方法 回顾性纳入2010年至2016年住院的35例男性IPAH患者及55例女性IPAH患者，平均年龄分别为（38.78±16.38）、（37.82±12.68）岁。所有患者均进行了右心导管检查及CPET。通过线性回归分析CPET参数对PVR的预测作用。结果 男性及女性IPAH患者的人口统计学，一般临床资料及血流动力学指标未见显著差异（P≥0.05）。但男性患者中Peak Workload、Peak VO2、AT、Peak VE、Peak VCO2、OUES、Peak O2 pulse明显高于女性患者（P<0.05）。部分CPET参数与PVR呈良好的相关性。多重线性回归分析提示： Peak O2 pulse及Peak PETCO2是所有IPAH患者PVR升高的独立预测因子。Peak PETCO2是男性IPAH患者PVR升高的独立预测因子，而Peak O2 pulse是女性IPAH患者PVR升高的独立预测因子。结论 CPET参数中能预测IPAH患者PVR升高的独立预测因子存在显著性别差异，这有利于采用不同CPET参数更加准确的分别预测男性及女性IPAH患者疾病严重程度。

Gender differences of cardiopulmonary exercise test parameters in predicting pulmonary vascular resistance elevation for patients with idiopathic pulmonary arterial hypertension

Objective To explore the gender differences of cardiopulmonary exercise testing (CPET) parameters for predicting pulmonary vascular resistance (PVR) elevation in patients with idiopathic pulmonary arterial hypertension (IPAH). Methods Ninety patients with IPAH (35 males and 55 females) undergoing right-heart catheterization (RHC) at Shanghai Pulmonary Hospital from 2010 to 2016 were enrolled in the study. The cardiopulmonary exercise test was also performed in all patients, and the predictive value of CPET parameters was analyzed with linear regression analysis. Results There were no significant differences in demographics, clinical parameters and hemodynamics between male and female patients. Peak workload, peak VO2, AT, peak VE, peak VCO2, OUES, peak O2 pulse were significantly higher in male patients than those in female patients (P<0.05). The regression analysis showed that peak O2 pulse and PETCO2 were independent predictors of PVR elevation in all patients; PETCO2 was an independent predictor of increased PVR for male IPAH patients, while Peak O2 pulse was an independent predictor of PVR elevation for female IPAH patients. Conclusion CPET parameters can be used as predictors of PVR elevation in IPAH patients, there is a gender difference when different CPET parameters are used.