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目的通过心肺运动试验研究特发性肺纤维化(IPF)对患者通气有效性及其运动耐力的影响。方法对2012年4月至2013年4月确诊为IPF的28例患者(IPF组)和28名年龄、性别匹配的健康志愿者(正常对照组)进行常规肺功能检测、动脉血气分析和心肺运动试验,并测定相关参数。结果两组间年龄[(58±10)比(59±5)岁]、性别、BMI[(23.8±2.7)比(25.0±2.8)]差异均无统计学意义(均P>0.05)。IPF组用力肺活量占预计值百分比、第1秒用力呼气容积占预计值百分比、最大分钟通气量占预计值百分比、肺总量占预计值百分比、残气量占预计值百分比、肺CO弥散量占预计值百分比均显著低于正常对照组,分别为(74.8±14.6)%比(101.8±10.8)%、(73.8%±14.6%)比(97.0%±10.1%)、(77.5%±14.9%)比(95.4%±24.5%)、(75.6%±12.4%)比(99.8%±5.4%)、(80.7%±15.4%)比(95.8%±11.3%)、(66.3%±13.7%)比(103.2%±17.3%),均P<0.01。IPF组PaO2、SaO2低于正常对照组,分别为(72.7±7.3)mmHg(1 mmHg=0.133 kPa)比(92.6±3.8)mmHg、(94.3%±2.1%)比(98.3%±0.7%),均P<0.01,而IPF组的肺泡动脉氧分压差则明显高于正常对照组[(33.3±5.7)mmHg比(17.8±1.9)mmHg,P<0.01]。心肺运动试验结果显示,IPF组每分钟通气量与CO2排出量(VE/VCO2)的线性斜率、VE/VCO2最小值均显著高于正常对照组,分别为(37.4±5.3)比(25.7±2.5)、(39.2±6.7)比(30.6±2.7),均P<0.01;IPF组4个时期的VE/VCO2和死腔气量与潮气量比均显著高于正常对照组(均P<0.01);IPF组峰值运动负荷占预计值百分比、峰值摄氧量占预计值百分比显著低于正常对照组,分别为(70.4%±29.9%)比(104.8%±29.7%)、(68.7%±29.8%)比(98.7%±36.4%),均P<0.01。IPF患者无氧阈时的每分钟通气量与C02排出量比值(VE/VCO2@AT)、VE/VCO2线性斜率及VE/VCO2最小值与静息时的肺CO弥散量占预计值百分比呈负相关(分别为r=-0.589,P<0.01;r=-0.481,P<0.05;r=-0.527,P<0.05),其峰值摄氧量占预计值百分比与VE/VCO2@AT、VE/VCO2线性斜率、VE/VCO2最小值呈负相关(分别为r=-0.548,P<0.05;r=-0.539,P<0.05;r=-0.564,P<0.05)。结论特发性肺纤维化使患者的通气有效性明显降低,严重影响患者的运动耐力。
Objective To investigate the effect of idiopathic pulmonary fibrosis (IPF) on ventilatory effectiveness and exercise endurance in patients through cardiopulmonary exercise test. Methods Twenty-eight patients (IPF group) and 28 age-matched and healthy-matched healthy volunteers (normal control group) diagnosed with IPF from April 2012 to April 2013 underwent routine pulmonary function tests, arterial blood gas analysis and cardiopulmonary exercise Test, and determine the relevant parameters. Results There were no significant differences in age [(58 ± 10) vs (59 ± 5) years], sex, BMI (23.8 ± 2.7) and (25.0 ± 2.8) between the two groups (all P> 0.05). The forced expiratory volume of IPF group accounted for the predicted percentage, the first second forced expiratory volume as a percentage of predicted value, the maximum minute ventilation accounted for the predicted percentage, the total lung accounted for the predicted percentage, residual volume accounted for the expected percentage, (74.8 ± 14.6)% (101.8 ± 10.8)%, (73.8% ± 14.6%), (97.0% ± 10.1%) and (77.5% ± 14.9%) in the control group, respectively. (95.4% ± 24.5%), (75.6% ± 12.4%) vs (99.8% ± 5.4%), (80.7% ± 15.4%) vs (95.8% ± 11.3% vs 66.3% ± 13.7% 103.2% ± 17.3%), all P <0.01. PaO2 and SaO2 in IPF group were significantly lower than those in control group (72.7 ± 7.3 mmHg, 92.6 ± 3.8 mmHg, 94.3% ± 2.1% vs 98.3% ± 0.7%, respectively) (P <0.01). The difference of oxygen partial pressure in alveolar artery in IPF group was significantly higher than that in control group [(33.3 ± 5.7) mmHg vs (17.8 ± 1.9) mmHg, P <0.01). The results of cardiopulmonary exercise showed that the linear slope of VE / VCO2 and the minimum value of VE / VCO2 in IPF group were significantly higher than those in normal control group (37.4 ± 5.3) (25.7 ± 2.5 ), (39.2 ± 6.7) and (30.6 ± 2.7), respectively (all P <0.01). The VE / VCO2 and dead space volume and tidal volume ratio in IPF group were significantly higher than those in normal control group (all P <0.01) The percentage of peak exercise load in the IPF group was predicted, and the percentage of peak oxygen uptake was significantly lower than that in the normal control group (70.4% ± 29.9% vs. (104.8% ± 29.7%, 68.7% ± 29.8% (98.7% ± 36.4%), all P <0.01. The ratio of minute ventilation to C02 emission (VE / VCO2 @ AT), VE / VCO2 linear slope, and VE / VCO2 minimum at the anaerobic threshold of IPF patients and the percentage of pulmonary CO diffusion at rest at IPF were negative (P <0.01; r = -0.481, P <0.05; r = -0.527, P <0.05). The correlation between peak oxygen uptake and VE / VCO2 @ AT and VE / The linear slope of VCO2 and the minimum of VE / VCO2 were negatively correlated (r = -0.548, P <0.05; r = -0.539, P <0.05, r = -0.564, P <0.05, respectively). Conclusions Idiopathic pulmonary fibrosis significantly reduced the effectiveness of ventilation in patients and seriously affected the patient’s exercise tolerance.