心率恢复评估系统性红斑狼疮相关肺动脉高压女性患者疾病严重程度的价值

目的 探讨心率恢复评估系统性红斑狼疮相关肺动脉高压(SLE-PAH)女性患者疾病严重程度的价值.方法 回顾性纳入2009年11月到2015年9月在同济大学附属上海市肺科医院住院治疗的21例SLE-PAH女性患者,对所有患者进行右心导管检查、肺功能测试及心肺运动试验,并以同期年龄、性别、体质量指数上匹配的32名女性健康志愿者为正常对照组进行对比分析.结果 与正常组相比,SLE-PAH患者的峰值公斤摄氧量(Peak VO2/kg)、峰值摄氧量占预计值百分比(PeakVO2％ pred)、峰值心率(Peak HR)、摄氧效率平台(OUEP)及OUEP％ pred显著下降(t=-8.59～-2.49,P＜0.05),最低通气效率(Lowest VE/VCO2)及Lowest VE/VCO2％ pred明显升高(t=4.85、5.48,P＜0.01),2组间基础心率差异无统计学意义(t=0.34,P＞0.05),而SLE-PAH患者的HRR1、HRR2[(19.1±7.4)次/min、(34.7±11.1)次/min]却显著低于正常对照组[(28.0±6.3)次/min、(42.0±8.3)次/min](t=-4.73、-2.73,P＜0.05).Pearson相关性分析发现SLE-PAH患者HRR1及HRR2与Peak VO2％ pred、OUEP％ pred、心输出量(CO)、心指数(CI)均呈中度正相关(r =0.47～0.69,P＜0.05),与Lowest VE/VCO2％ pred呈中度负相关(r=-0.62、-0.55,P＜0.05),与mPAP无相关性(r=-0.35、-0.11,P＞0.05).此外,HRR1还与肺血管阻力(PVR)呈弱正相关(r=-0.45,P＜0.05),而PVR与HRR2无相关性(r=-0.31,P＞0.05).ROC曲线显示HRR1及HRR2曲线下面积分别为0.807(敏感度84.4％,特异度71.4％)及0.676(敏感度68.8％,特异度71.4％)(P＜0.05),HRR1及HRR2在ROC曲线上的分界点分别为23次/min及40次/min.结论 HRR1及HRR2均可以用来评估SLE-PAH女性患者疾病严重程度.因此,我们可以把HRR作为早期发现SLE-PAH的一个重要参数,并对疾病严重程度进行评估从而判断预后.

Heart rate recovery evaluates the severity of pulmonary arterial hypertension due to systemic lupus erythematosus in women patients

Objective To explore the value of heart rate recovery (HRR) on evaluating the severity of pulmonary arterial hypertension (PAH) due to systemic lupus erythematosus (SLE) in women patients.Methods The clinical data were retrospectively analyzed for 21 patients with SLE-PAH from Shanghai Pulmonary Hospital from November 2009 to September 2015.All the patients underwent rightheart catheterization,pulmonary function test and cardiopulmonary exercise testing (CPET).For a comparison the patients matched 32 healthy subjects in age,sex and BMI acted as control group.Results Compared with control group,patients with SLE-PAH had a significantly lower Peak VO2/kg,Peak VO2 ％ pred,Peak HR,OUEP and OUEP％ pred (t =-8.59～-2.49,all P ＜0.05).However,there was significant increase of Lowest VE/VCO2 and Lowest VE/VCO2 ％pred in SLE-PAH group than control group (t =4.85,5.48,both P ＜0.01),what's more,there was no significant in rest heart rate between two groups(t =0.34,P ＞0.05).HRR1 and HRR2 were much lower in SLE-PAH group than in control group [(19.1±7.4) beats/min vs.(34.7±11.1) beats/min,(20.8±6.3) beats/min vs.(42.0±8.3) beats/min,respectively] (t =-4.731,-2.732,both P ＜0.05).Pearson correlation revealed HRR1 and HRR2 had moderate positive correlation with Peak VO2 ％ pred,OUEP％ pred,CO and CI (r =0.47～ 0.69,all P ＜0.05),and moderate negative correlation with Lowest VE/VCO2％ pred (r =-0.62,-0.55,bothP ＜0.05),no significant with mPAP(r =-0.35,-0.11,both P ＞0.05).Moreover,HRR1 had weak positive correlation with PVR (r =-0.45,P ＜0.05),except HRR2(r =-0.31,P ＞ 0.05).By ROC analysis,HRR1＜23 beat/min had 84.4％ of sensitivity and 71.4％ of specificity with 0.807 of AUC area (P ＜0.05),and HRR2＜40 beat/min had 68.8％ of sensitivity and 71.4％ of specificity with 0.676 of AUC area (P ＜0.05).Conclusions HRR1 and HRR2 can both evaluate the severity of pulmonary arterial hypertension due to systemic lupus erythematosus in woman patients.Therefore,we can regard HRR1 and HRR2 as an important parameter to detect SLE-PAH disease early,to evaluate the severity of disease and to judge prognosis of disease.