摘要目的：探讨肺动脉高压患者次极量运动参数与峰值摄氧量（ P-VO2）的相关性。方法回顾性分析2010年10月至2013年10月在同济大学附属上海市肺科医院住院治疗的106例肺动脉高压患者（肺动脉高压组）的临床资料，包括肺功能、氨基末端脑利钠肽前体（ NT-proBNP ）测定、6 min步行试验、右心导管检查及心肺运动试验的结果资料，并以同期无吸烟史、无心肺疾病及基线资料匹配的20名健康志愿者为对照组进行对比分析。结果肺动脉高压组的P-VO2、无氧阈（ AT）、摄氧效率斜率（OUES）和摄氧效率平台（OUEP）均显著低于对照组[（841±257）比（1682±284）ml/min、（661±171）比（1041±243）ml/min、1.1±0.4比2.3±0.4和25.8±5.2比35.5±4.0]，各参数占预计值的百分比（％预计值）也均显著低于对照组（均P＜0.001）。而最低通气效率[分钟通气量（ VE）与CO2排出量（VCO2）比值的最低值（L-VE/VCO2）]和VE/VCO2斜率显著高于对照组（50.5±15.9比30.5±3.0和57.2±23.2比25.6±2.8，均P＜0.001）。 Pearson相关分析显示，除VE/VCO2斜率％预计值外，AT％预计值、L-VE/VCO2％预计值、OUES％预计值及OUEP％预计值均与P-VO2％预计值相关（均P＜0.001）。多重线性回归发现，只有AT％预计值与OUES％预计值是P-VO2％预计值的独立预测指标（β＝0.394和0.384，均P＜0.001），且OUES％预计值对运动耐力的影响更大（校正β＝0.674）。当AT％预计值以58.0％为分界点、OUES％预计值以65.0％为分界点时，诊断肺动脉高压患者运动耐力严重降低的敏感度和特异度分别为92.3％、96.2％和81.2％、75.5％。结论肺动脉高压患者的运动耐力降低，次极量运动参数OUES％预计值及AT％预计值可作为评估运动耐力的独立预测指标，且OUES％预计值预估价值可能更高。

abstractsObjective To explore the correlation between submaximal exercise measurements and peak oxygen uptake in patients with pulmonary arterial hypertension ( PAH) .Methods The clinical data were retrospectively analyzed for 106 patients with PAH from Affiliated Shanghai Pulmonary Hospital , Tongji University from October 2010 to October 2013.The examinations included routine pulmonary function test , N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk test, right heart catheterization and cardiopulmonary exercise testing.And within the same period , matched 20 healthy subjects without smoking and cardiopulmonary diseases were selected as control group .Results Peak oxygen uptake ( P-VO2 ) , anaerobic threshold (AT), oxygen uptake efficiency slope ( OUES) and oxygen uptake efficiency plateau (OUEP) were significantly lower in patients with PAH than control group ((841 ±257) vs (1 682 ±284) ml/min, (661 ±171) vs (1 041 ±243) ml/min, 1.1 ±0.4 vs 2.3 ±0.4, 25.8 ±5.2 vs 35.5 ±4.0,respectively) (all P<0.001).And the predicted parametric values (%pred) were also lower in PAH group than control group (all P <0.001).While the lowest ventilation (VE)/CO2 output (VCO2) (L-VE/VCO2 ) and VE/VCO2 slope were significantly higher in PAH group than control group ( 50.5 ±15.9 vs 30.5 ±3.0 and 57.2 ±23.2 vs 25.6 ±2.8, both P<0.001).Pearson correlation analysis showed , except for VE/VCO2 slope%pred, AT%pred, L-VE/VCO2%pred, OUES%pred and OUEP%pred were correlated with P-VO2(all P<0.001).According to multiple linear regression analysis , only AT%pred and OUES%pred were the independent predictors of P-VO2 (β=0.394, 0.384, both P <0.001 ) and OUES%pred might be better than AT%pred ( the adjusted β=0.674 ).When AT%pred<58.0% or OUES%pred<65.0%, exercise capacity in PAH declined obviously with the sensitivity was 92.3% and 96.2% and the specificity 81.2% and 75.5% respectively .Conclusions Exercise capacity in patients with PAH is significantly lower than healthy subjects.OUES%pred and AT%pred may be used as an independent predictor of exercise capacity.And OUES%pred may be more powerful .