Responses to exercise in systemic sclerosis-associated interstitial lung disease

IF 1.3 4区 医学 Q4 PHYSIOLOGY
Ronan P. Donnelly, Anita E. Smyth, Charles Mullan, Marshall S. Riley, D. Paul Nicholls
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Abstract

Introduction

Pulmonary complications in systemic sclerosis (SSc) significantly increase morbidity and mortality. Our aim was to determine the factors limiting exercise capacity in SSc patients with and without interstitial lung disease (ILD), and to identify and quantify abnormalities during exercise that might assist in clinical assessment of this complication.

Methods

Fifteen patients with SSc and ILD (SSc-ILD) were compared with 10 patients with SSc without ILD and 9 age- and sex-matched normal volunteers. Subjects performed symptom-limited incremental treadmill exercise with online measurement of respiratory gas exchange, arterial blood gas sampling and measurement of neurohormones in venous blood.

Results

Patients with SSc-ILD had lower exercise capacity than SSc patients without ILD or normal subjects (peak oxygen consumption (PV̇O2) (17.1 [4.2] vs. 22.0 [4.7] and 23.0 [5.4] ml kg−1 min−1, respectively, mean [SD], p < 0.01 ANOVA), but PV̇O2 did not correlate with static pulmonary function measurements. Ventilatory equivalent for CO2 (V̇E/V̇CO2; nadir) was higher in SSc-ILD patients than the other two groups (36.6 [8.0] vs. 29.9 [4.4] and 30.0 [2.5], p < 0.005) as were peak exercise dead-space tidal volume ratio (0.44 [0.06] vs. 0.26 [0.09] and 0.26 [0.05], p < 0.001) and peak exercise alveolar–arterial difference (28.9 [16.9] vs. 18.8 [14.0] and 11.5 [6.9] mmHg, p < 0.05). Atrial natriuretic peptide was elevated in both SSc patient groups.

Conclusions

SSc-ILD results in lower exercise capacity than SSc without ILD, and abnormalities of gas exchange are seen. The possible use of cardiopulmonary exercise testing to identify disease and quantify impairment in SSc-ILD merits further study.

运动对系统性硬化症相关间质性肺疾病的影响
系统性硬化症(SSc)的肺部并发症显著增加发病率和死亡率。我们的目的是确定伴有或不伴有间质性肺疾病(ILD)的SSc患者运动能力的限制因素,并确定和量化运动过程中的异常,这些异常可能有助于临床评估这一并发症。方法将15例SSc合并ILD患者(SSc-ILD)与10例SSc无ILD患者和9例年龄、性别匹配的正常人进行比较。受试者进行症状限制的渐进式跑步机运动,同时在线测量呼吸气体交换、动脉血气采样和静脉血中神经激素的测量。结果SSc-ILD患者的运动能力低于无ILD的SSc患者或正常受试者(峰值耗氧量(PV (O2))(分别为17.1[4.2]对22.0[4.7]和23.0 [5.4]ml kg - 1 min - 1,平均[SD], p < 0.01方差分析),但PV (O2)与静态肺功能测量无相关性。通风CO2当量(V * E/V * CO2;SSc-ILD患者的nadir)高于其他两组(36.6[8.0]比29.9[4.4]和30.0 [2.5],p < 0.005),运动峰值死空潮气量比(0.44[0.06]比0.26[0.09]和0.26 [0.05],p < 0.001)和运动峰值肺泡动脉差(28.9[16.9]比18.8[14.0]和11.5 [6.9]mmHg, p < 0.05)。两组患者心房利钠肽均升高。结论SSc-ILD患者的运动能力低于无ILD的SSc,且气体交换异常。心肺运动试验在SSc-ILD中识别疾病和量化损害的可能性值得进一步研究。
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来源期刊
CiteScore
3.40
自引率
5.60%
发文量
62
审稿时长
6-12 weeks
期刊介绍: Clinical Physiology and Functional Imaging publishes reports on clinical and experimental research pertinent to human physiology in health and disease. The scope of the Journal is very broad, covering all aspects of the regulatory system in the cardiovascular, renal and pulmonary systems with special emphasis on methodological aspects. The focus for the journal is, however, work that has potential clinical relevance. The Journal also features review articles on recent front-line research within these fields of interest. Covered by the major abstracting services including Current Contents and Science Citation Index, Clinical Physiology and Functional Imaging plays an important role in providing effective and productive communication among clinical physiologists world-wide.
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