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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 152-157. doi: 10.19723/j.issn.1671-167X.2020.01.024

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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

任川1,吴晓月1,赵威1,2,△(),陶立元3,刘萍1,高炜1   

  1. 1. 北京大学第三医院心内科,北京大学第三医院血管医学研究所,国家卫生健康委员会心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,心血管受体研究北京市重点实验室,北京 100191
    2. 北京大学第三医院体检中心,北京 100191
    3. 北京大学第三医院临床流行病学研究中心,北京 100191
  • 收稿日期:2019-09-24 出版日期:2020-02-18 发布日期:2020-02-20
  • 通讯作者: 赵威 E-mail:beate_vv@ bjmu.edu.cn
  • 基金资助:
    “立信扬帆”科研基金(BJUHFCSOARF201801-11);首都临床特色应用研究与成果推广基金(Z151100004015047);国家自然科学基金(81601968)

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

Chuan REN1,Xiao-yue WU1,Wei ZHAO1,2,△(),Li-yuan TAO3,Ping LIU1,Wei GAO1   

  1. 1. Department of Cardiology, Peking University Third Hospital; Institute of Vascular Medicine of Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides of National Health Commission; Key Laboratory of Molecular Cardiovascular Science of Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China
    2. Physical Examination Center, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-09-24 Online:2020-02-18 Published:2020-02-20
  • Contact: Wei ZHAO E-mail:beate_vv@ bjmu.edu.cn
  • Supported by:
    Supported by the CS Optimizing Antithrombotic Research Fund(BJUHFCSOARF201801-11);Capital Clinical Application Research and Promotion Projects of Beijing Municipal Science and Technology Commission(Z151100004015047);National Natural Science Foundation of China(81601968)

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摘要：

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。

关键词: 动脉粥样硬化性心血管疾病, 危险分层, 心肺运动试验, 心肺适能

Abstract:

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.

Key words: Arteriosclerotic cardiovascular disease, Risk stratification, Cardiopulmonary exercise testing, Cardiorespiratory fitness

中图分类号: 

  • R541.4

表1

ASCVD组和非ASCVD组的基线资料"

Items Non ASCVD group(n=455) ASCVD group(n=51) P
Age/years, x?±s 56.0±13.1 63.7±9.2 <0.001
Gender 0.084
Male, n(%) 224(49.2) 32(62.7)
Female, n (%) 231(50.8) 19(37.3)
BMI/(kg/m2), x?±s 25.3±3.8 26.2±3.0 0.105
Medical History
Hypertension, n (%) 189(41.5) 30(58.8) 0.023
Hyperlipidemia, n (%) 196(43.1) 25(49.0) 0.473
Diabetes, n (%) 82(18.0) 13(25.5) 0.215
Smoking, n (%) 118(25.9) 17(33.3) 0.287
Laboratory tests
TC/(mmol/L), x?±s 4.71±0.97 4.43±1.18 0.058
LDL-C/(mmol/L), M(IQR) 1.88(1.01) 2.13(0.71) 0.616
HDL-C/(mmol/L), M(IQR) 1.16(0.20) 1.05(0.22) 0.011
TG/(mmol/L), x?±s 2.53±1.02 2.31±1.04 0.163
FBG/(mmol/L), M(IQR) 5.5(0.7) 5.7(0.8) 0.805
HbAlc, n (%) 5.9(0.6) 6.1(0.8) 0.433
Medication
ACEI/ARB, n (%) 73(16.0) 13(25.4) 0.204
β-blockers, n (%) 54(11.9) 8(15.7) 0.456
Calcium channel blockers, n (%) 82(18.0) 16(31.4) 0.026
Statins, n (%) 103(22.6) 23(45.1) 0.001
Aspirin, n (%) 60(13.2) 19(37.3) <0.001
Cardiopulmonary exercise testing
VO2peak/[mL/(kg·min)], M(ITR) 19.1(3.2) 16.3(3.6) <0.001
Positive result, n (%) 30(6.6) 4(7.8) 0.189

表2

ASCVD危险分层高危和中、低危患者中ASCVD组和非ASCVD组的基线资料"

Items Low /moderate risk High risk
Non ASCVD group
(n=313)		 ASCVD group
(n=30)		 P Non ASCVD group
(n=142)		 ASCVD group
(n=21)		 P
Age/years, x?±s 55.3±13.6 65.1±9.1 <0.001 57.6±11.6 61.8±9.2 0.117
Gender 0.152 0.479
Male, n(%) 145(46.3) 18(60.0) 79(55.6) 14(66.7)
Female, n (%) 168(53.7) 12(40.0) 63(44.4) 7(33.3)
BMI, kg/m2 24.8±3.5 26.2±2.8 0.039 26.6±4.0 26.3±3.4 0.740
Medical History
Hypertension, n (%) 93(29.7) 14(46.7) 0.056 96(67.7) 16(76.2) 0.630
Hyperlipidemia, n (%) 121(38.6) 12(40.0) 0.885 75(52.8) 13(61.9) 0.585
Diabetes, n (%) 6(1.9) 2(6.7) 0.100 76(53.5) 11(52.4) 0.737
Smoking, n (%) 60(19.2) 8(26.7) 0.325 58(40.8) 9(42.9) 0.993
Laboratory tests
TC/(mmol/L), x?±s 4.66±0.90 4.16±1.04 0.005 4.84±1.09 4.83±1.29 0.957
LDL-C/(mmol/L), M(IQR) 1.75(1.02) 1.74(1.22) 0.637 2.26(0.77) 2.46(0.74) 0.186
HDL-C/(mmol/L), M(IQR) 1.20(0.19) 1.11(0.20) 0.084 1.02(0.20) 0.90(0.33) 0.326
TG/(mmol/L), x?±s 2.41±0.97 2.06±0.80 0.052 2.80±1.07 2.66±1.24 0.588
FBG/(mmol/L), M(IQR) 5.4(0.5) 5.6(0.3) 0.735 6.4(1.6) 6.2(1.6) 0.341
HbAlc, n (%) 5.7(0.3) 5.7(0.5) 0.575 6.5(1.5) 6.6(1.3) 0.961
Medication
ACEI/ARB, n (%) 41(13.1) 5(16.7) 0.584 32(22.5) 8(38.1) 0.122
β-blockers, n (%) 32(10.2) 3(10.0) 0.969 22(15.5) 5(23.8) 0.397
Calcium channel blockers, n (%) 45(14.4) 9(30.0) 0.025 37(26.1) 7(33.3) 0.575
Statins, n (%) 70(22.3) 14(46.7) 0.004 33(23.2) 9(42.9) 0.052
Aspirin, n (%) 43(13.7) 10(33.3) 0.005 17(12.0) 9(42.9) 0.001
Cardiopulmonary exercise testing
VO2peak, mL/(kg·min), M(ITR) 19.4(3.1) 16.1(4.4) 0.006 18.8(2.8) 16.3(1.7) 0.014
Positive result, n (%) 16(5.1) 2(6.7) 0.340 14(9.9) 2(9.5) 0.242

图1

在ASCVD危险分层高危和中、低危患者中,不同水平的VO2peak与ASCVD事件相关性的Logistic回归"

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ISSN 1671-167X
CN 11-4691/R
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