|
Background: Chronic obstructive pulmonary disease (chronic obstructive pulmonary disease, COPD) is a disease characterized by airflow limitation. The airflow limitation was not fully reversible, and showed progressive development, abnormal inflammatory response of the lungs of harmful gases or harmful particles. COPD is a common and frequently occurring respiratory disease, morbidity and mortality are high, the main clinical features of this disease can be expressed not only internal inflammatory changes of the lung, but also affect the changes in lung structure, due to pulmonary dysfunction, serious impact on the patient's workforce, quality of life and exercise tolerance, the World Health Organization (WHO) data show that the mortality of COPD ranks fourth of all causes of death in North America, and the trend of increasing year by year. In the United States, for example, in 2020, the deaths caused by COPD will be the fourth increase in third place. Resting pulmonary function tests (resting pulmonary function test, PFT) is the main objective indicators to determine airflow limitation, the significance of the COPD diagnosis, evaluation of the severity of disease progression, prognosis and treatment response. The main indicators including one second forced expiratory volume occupies a percentage of vital capacity (FEV1/FVC) and the first second forced expiratory volume (FEV1), FEV1/FVC is a sensitive indicator of the evaluation of airflow limitation is the assessment of COPD a good indicator of the severity of. FEV1 in the percentage of the value is a commonly used indicator of COPD diagnosis, disease classification and assessment of prognosis, but the FEV1 mainly reflect airflow obstruction, evaluation of COPD has some limitations, can not reflect the amount of exercise tolerance of the patients in the state of motion and cardiopulmonary The function of the reserve. Cardiopulmonary exercise testing (Cardiopulmonary exercise testing, CPET) is a comprehensive evaluation of the state of motion (respiratory system, cardiovascular system, blood system, nervous system, musculoskeletal system including) the overall function of the organ systems, it is a species of relatively non-invasive evaluation of cardiopulmonary functional reserve and the exercise endurance detection method, the integrated application respiratory gas monitoring technology, computer and treadmill or treadmill technology, real-time detection under different load conditions, the body's oxygen consumption and carbon dioxide emission dynamic changes, thus an objective, quantitative evaluation of cardiopulmonary functional reserve, exercise tolerance, and to provide the appropriate clinical information for physicians diagnosis. CPET is one of the ways of the heart and lung function tests commonly used to measure the level of human respiratory and circulatory functions. CPET in maximum oxygen uptake (VO2 max) subjects in the final stages of the movement to make every effort, circulatory and respiratory systems work best when organizations cells per minute, the amount of oxygen intake, its normal by gender, age cardiovascular circulation, muscle tissue oxygen uptake of these three systems ability level, height, weight, etc. are expected, but the actual measured value with pulmonary respiration (including ventilation and ventilatory function), and coupling activities mainly reflects the exercise tolerance in patients compared with PFT or single heart function tests predict surgical complications and disease mortality advantage. But due to some reasons CPET not widely used, a number of studies in patients with COPD resting lung function and cardiopulmonary exercise relationship study found that compared with resting pulmonary function, cardiopulmonary exercise test to better predict the survival rate of patients with COPD and exercise tolerance. Another study also found that resting pulmonary function tests - some indicators with CPET in VO2max correlation, the more common indicators for FEVI, MVV, PEF. Another foreign scholars through research resting relationship between lung function and VO2max, launch calculation VO2max formula. Objective: To validate the foreign VO2vmax formula accurately set and applicability, summed up the domestic resting pulmonary function test results the formula with maximal oxygen uptake and verify the accuracy of the formula. 129 study: January 2009 -2010 in February for treatment at the Guangdong Provincial People's Hospital, medical clinic, line resting pulmonary function tests in patients with chronic obstructive pulmonary disease, divided period, January 2009 - 2009 10 months, a total of 104 patients included in the previous study, male 74 cases, female 30 cases, for the test group. November 2009 - February 2010, a total of 25 patients were included in the latter part of study, including 18 males and 7 females, for the validation group. Inclusion criteria: chronic obstructive pulmonary disease stabilization period, to avoid acute exacerbation for at least three months or more, and disable inhaled short-acting β2 receptor agonists or anticholinergic 4-6 hours, stop using oral short-acting β2 disabled for more than 24 hours, 8 hours, long-acting or sustained release type of receptor agonists or theophylline antihistamines 48 hours, and is disabled the oral glucocorticoid stopped 24 hours, inhalation stopped 12 hours. Exclusion criteria: (1) asthma patients or patients with a history of asthma or bronchial dilation test positive patients suffering from bronchial past. (2) inhalation of indoor air cases with severe hypoxemia (PaO2 lt; 45mmHg) or hypercapnia (PaCO2 gt; 70mmHg); (3) FEV1 lt; 20%; (4) heavy physical deformity is not corrected by heart disease (such as height lt; 155cm; peripheral vascular disease or neurological disease caused by the movement is limited; anemia; (5) severe pulmonary hypertension; (6) diabetes; (7) hypertension; (8) coronary artery disease; recent myocardial infarction; unstable angina; acute pulmonary embolism or pulmonary embolism; II - III degree heart atrioventricular block; the rapid ventricular / Room arrhythmia; severe aortic stenosis; congestive heart failure; wall aneurysm; valvular heart disease): (9) refused to line included in the study or line cardiopulmonary exercise function tests. Method: 1. Resting pulmonary function test and arterial blood gas analysis of the records of all subjects of height, weight, gender, BSA and BMI, calculated according to the formula and record. Reference to ATS / ERS (American Thoracic Society / European Respiratory Society) pulmonary function instrument allegations standards, all subjects resting pulmonary function testing, test parameters: (1) forced pulmonary ventilation function: forced vital capacity (FVC), the first one second forced vital capacity (FEV1), first second forced expiratory volume with the amount of vital capacity ratio (FEV1/FVC), the third second FVC (FEV3), the average mid-forced expiratory flow rate (FEF25% -75%), maximal expiratory gas flow (PEF); (2) maximum voluntary ventilation function: MVV; (3) lung volume check: vital capacity (VC), took a deep gas (IC), the lung total (TLC), residual gas (RV); ( 4) Determination of airway resistance; the Raw; (5) dispersion function test: DLCO; arterial blood gas analysis: Determination of PH, PO2 PCO22 cardiopulmonary exercise sports instrument power bike (treadmill) test. 3 exercise test methods using one minute sloping the incremental power bike (treadmill) program, the beginning of the exercise test, the first three minutes of warm-up load treadmill exercise (0W), 3 minutes after the incremental movement to maintain per minute increase in the same power until the patients by symptom-limited or can not continue until safety campaigns, and record the maximum oxygen uptake value (VO2max), throughout the course of the campaign speed maintained at 60 rpm. 4 used to estimate the calculation formula of the maximal oxygen Efremidis people: VO2max of (L / min) = (FEF25.75% x 0.47) (BAS × 0.988) (MVV × 0.024) -0.913 (r2 = 0.81) SPSS13.0 statistical software package, statistical methods for statistical analysis of the data, the measurement data using the mean ± standard deviation (x ± s) described two sample two independent samples t-test was used to compare resting lung function, Arterial blood gas analysis VO2max correlated indicators Yungong cardiopulmonary function measured using multiple linear regression method stepwise regression regression analysis of the data and the regression equation. P lt; 0.05, the difference was statistically significant. Results: The experimental group were included 104 patients with COPD, including male and 74 cases, 30 were females, which belongs Ⅰ level of 12 people with chronic obstructive pulmonary disease, grade Ⅱ 81 grade III, 11 grade IV 0 people , the validation group enrolled 25 patients with COPD, including 18 males and 7 females, belonging to chronic obstructive pulmonary disease grade Ⅰ, grade 24 Ⅱ, Ⅲ and Ⅳ grade 0, general information for the average age (65.57 ± 6.71 and 64.56 ± 7.56, t = 0.657; P = 0.512), height (1.64 ± 0.07 and 1.66 ± 0.08; t = -1.131; P = 0.260), body weight (58.48 ± 9.63 and 59.36 ± 8.32; t = -0.420, P = 0.675), BSA (1.60 ± 0.14 and 1.62 ± 0.12; t = -0.724; P = 0.470), BMI (21.66 ± 3.69 and 21.63 ± 3.65; t = 0.045; P = 0.965), two groups of resting lung function FVC measured value (2.95 ± 0.55 and 3.12 ± 0.65; t = -1.380; P = 0.170), FVC% predicted value percentage (87.05 ± 12.88 and 89.84 ± 9.34), FEV1 measured were (1.72 ± 0.42 and 1.80, respectively. ± 0.38; -0.840; P = 0.402), FEV1 percentage of predicted value percentage (65.31 ± 12.57 and 66.84 ± 9.86), FEV1/FVC%, respectively (58.14 ± 8.30 and 57.80 ± 8.82), FEV3 measured values ??were ( 2.39 ± 0.62 and 2.60 ± 0.63; t = -1.484; P = 0.140), FEV3 accounting for the expected value of the percentage were (75.10 ± 15.50 and 80.44 ± 11.95), FEF25-75% of the measured value, respectively (1.03 ± 0.49 and 1.04 ± 0.37; t = -0.101; P = 0.920), FEF25-75% accounted for were predicted value (44.43 ± 17.40 and 43.92 ± 15.00) the FEF50% measured were (1.11 ± 0.49 and 1.18 ± 0.45, t = - 0.582; P = 0.562), FEF50% accounted for the expected value percentage (34.13 ± 13.54 and 35.88 ± 12.88) the FEF75% measured were (0.36 ± 0.15 and 0.35 ± 0.18; t = 0.343; P = 0.732), FEF75 % percentage of predicted value percentage (42.57 ± 20.13 and 47.00 ± 32.51), PEF measured values ??were (3.83 ± 1.22 and 4.23 ± 1.27; t = -1.433; P = 0.154), PEF accounted predicted value (47.72 ± 13.35 and 51.44 ± 13.44), MVV measured values ??were (60.00 ± 18.43 and 62.12 ± 15.79; t = -0.530; P = 0.597), MVV accounted predicted value (56.31 ± 14.59 and 59.36 ± 13.63), VC Found (3.12 ± 0.55 and 3.20 ± 0.56; t = -0.640; P = 0.523), VC percentage of predicted value percentage (89.90 ± 11.62 and 91.56 ± 9.94), respectively, the IC measured values ??were (1.60 ± 0.54 and 1.66 ± 0.42; t = -0.512; P = 0.609), IC percent predicted value percentage (62.72 ± 19.79 and 65.84 ± 16.83), the TLC measured values ??(6.73 ± 0.73 and 6.78 ± 0.87, respectively; t = -0.291; P = 0.772), TLC percentage of predicted were (117.62 ± 9.91 and 120.12 ± 11.92), the the RV measured value (3.48 ± 0.49 and 3.53 ± 0.66, respectively; t = -0.514; P = 0.608), RV% predicted percentages were (149.93 ± 28.93 and 149.16 ± 28.10), RV / TLC percentage (52.71 ± 6.42 and 52.28 ± 5.96), respectively, the DLCO accounted Found percentage (80.87 ± 19.74 and 83.32 ± 14.70; t = -0.583; P = 0.561), Raw measured (3.18 ± 0.47 and 2.95 ± 0.40, respectively; t = 2.295; P = 0.023), PH (7.42 ± 0.04 and 7.42 ± 0.04 respectively; t = 0.223; P = 0.824), PO2 projections VO2max (11.52 ± 0.84 and 10.80 ± 0.85; t = 3.845; P = 0.000), PCO2 were (4.31 ± 0.57 and 4.37 ± 0.27, t = -0.752; P = 0.454) 2. Efremid is The comparison between the calculation formula and measured values ??of the test group (x ± s). Visible test group measured value of 1.06 ± 0.30, Efremidis et al projected VO2max 2.59 ± 0.71, t = 20.267, P lt; 0.001 3 to age, height, weight, BMI, BAS, FVC, FEV1, FEF3 FEF25-75%, FEF50%, FEF75%, PEF, MVV, VC, IC, TLC, RV, DLCO, Raw as independent variables, maximal oxygen uptake as the dependent variable, multiple linear regression, stepwise regression analysis formula to predict the maximum oxygen uptake: VO2max of (L / min) = (FEF25-75% x 0.133) (BAS × 0.603) (MVV × 0.003) (DLCO × 0.005) -0.646 (R2 = 0.716) 4. validation group calculated by the above formula VO2max (1.07 ± 0.17) and validation group compared with the measured value (1.08 ± 0.24), t = 0.150, P = 0.881, that validation set of measured of VO2max and by formula derived VO2max difference was not statistically significance. Conclusions: 1 by Efremidis et al projected formula of maximal oxygen uptake (VO2max of (L / min) = (FEF25-75% x 0.47), (BAS 0.988) (MVV × 0.024) -0.913) compared to the actual measured VO2max was significantly lower than that by the the formula projected value that does not apply to domestic COPD patients. 2 for chronic obstructive pulmonary disease in patients with resting pulmonary function and exercise cardiopulmonary function test results, summed up for the first time the relationship between cardiopulmonary exercise maximal oxygen uptake (VO2max), resting lung function indicators through multi-line derived from the regression analysis formula: VO2max (L / min) = (FEF25-75% x 0.133) (BAS × 0.603) (MVV × 0.003) (DLCO × 0.005) -0.646 (R2 = 0.716), considering the maximum oxygen uptake amount FEF25-75%, BAS, MVV and DLCO related. Validation group validation formula: VO2max of (L / min) = (FEF25-75% x 0.133) (BAS × 0.603) (MVV × 0.003) (DLCO × 0.005) .0.646 (R2 = 0.716) preliminary consideration can be used to extrapolate VO2max.
|