评估和定制轻度至中度残疾的女性多发性硬化症患者的 VO2max 预测方程。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-11-02 DOI:10.1016/j.msard.2024.106154

Marco Morrone , Anna Boi , Lucia Ventura , Gianluca Martinez , Elena Aiello , Franca Deriu , Andrea Manca

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引用次数: 0

摘要

背景：用于预测健康人摄氧量峰值（VO2max）的既定公式并不能直接适用于患者群体，包括多发性硬化症患者（PwMS）。多发性硬化症患者通常会表现出心肺功能和神经肌肉功能受损，因此往往需要量身定制的预测模型。本研究旨在（1）测试在健康人群中广泛使用的四种公式的有效性、可靠性和准确性，以估算患有多发性硬化症的轻度至中度残疾妇女的 VO2max；（2）根据多发性硬化症的特征开发调整后的公式：方法：51 名患有复发缓解型多发性硬化症（RRMS）的轻度至中度残疾女性（平均年龄 46 岁，EDSS 中位数 3.5）使用循环测力法进行了增量心肺运动测试（CPET）。气体交换通过开路肺活量测定法进行分析。对四种常用的预测方程（ACSM、Storer's、Uth's 和 Myers's）进行了可靠性和准确性测试，并与测量的 VO2max 进行对比。通过回归分析确定了重要的 VO2max 预测因子，并进行了调整，以开发出针对不同性别的方程，用于估算不同运动参与程度的心肺功能：结果：ACSM和Storer方程低估了最大氧饱和度（分别为-6.09 %，Z = -3.22，p = 0.001；和-21.74 %，Z = -5.02，p < 0.001），而Uth和Myers方程则高估了最大氧饱和度（分别为+20.19 %，Z = -5.92，p < 0.001；和+19.31 %，Z = -6.19，p < 0.001）。调整方程的回归结果显示，ACSM 调整方程的工作率/体重（WR/BW）（β = 0.867，p < 0.001）；Storer 调整方程的年龄（β = -0.275，p = 0.004）、体重（β = -0.658，p < 0.001）和峰值瓦特（β = 0.485，p < 0.001）；心率比（β = 0.512，p < 0.001）（Uth's adjusted）；年龄（β = -0.492，p < 0.001）、体重（β = -0.483，p < 0.001）和 EDSS（β = -0.211，p = 0.046）（Myers's adjusted）作为 VO2max 的预测因子：结论：只要根据女性多发性硬化症患者的特征性功能障碍进行特定调整，就可以使用已建立的公式对其 VO2max 进行有效估算。本研究中提出的模型能够在不同运动参与程度的方案中对心肺功能进行可靠的评估，因此适用于临床和日常使用。这种方法支持 "从工作台到床边 "的转化驱动视角，允许在几乎所有环境中对患者进行 VO2max 评估。

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Assessing and tailoring predictive equations of VO2max for women with multiple sclerosis with mild to moderate disability

Background

Established equations to predict peak oxygen uptake (VO₂max) in healthy subjects are not directly applicable to patient populations, including people with multiple sclerosis (PwMS). PwMS, who commonly exhibit impaired cardiorespiratory and neuromuscular function, often require tailored predictive models. This study aimed at (1) testing the validity, reliability, and accuracy of four widely used formulae, developed in healthy populations, to estimate VO₂max in mildly to moderately disabled women with MS, and (2) develop adjusted formulae tailored on MS features.

Methods

Fifty-one mildly to moderately disabled women (mean age 46, median EDSS 3.5) with relapsing-remitting multiple sclerosis (RRMS) underwent incremental cardiopulmonary exercise testing (CPET) using cycle ergometry. Gas exchanges were analyzed by open-circuit spirometry. Four commonly employed predictive equations (ACSM, Storer's, Uth's, and Myers’) were tested for reliability and accuracy against measured VO₂max. Regressions were performed to identify significant VO₂max predictors and to introduce adjustments to develop gender-specific equations aimed at estimating cardiorespiratory fitness with varying degrees of exercise involvement.

Results

ACSM and Storer's equations underestimated VO₂max (-6.09 %, Z = -3.22, p = 0.001; and -21.74 %, Z = -5.02, p < 0.001, respectively) whereas Uth's and Myers’ equations overestimated it (+20.19 %, Z = -5.92, p < 0.001; and +19.31 %, Z = -6.19, p < 0.001, respectively). Regressions for adjusted equations revealed work rate/bodyweight (WR/BW) (β = 0.867, p < 0.001) for ACSM adjusted; age (β = -0.275, p = 0.004), BW (β = -0.658, p < 0.001) and peak Watts (β = 0.485, p < 0.001) for Storer's adjusted; heart rate ratio (β = 0.512, p < 0.001) for Uth's adjusted, and age (β = -0.492, p < 0.001), BW (β = -0.483, p < 0.001) and EDSS (β = -0.211, p = 0.046) for Myers’ adjusted as predictors of VO₂max.

Conclusions

VO₂max can be validly estimated in women with MS using established formulae, provided that specific adjustments are introduced to account for their signature functional impairments. The models proposed in this study enable reliable assessment of cardiorespiratory fitness with protocols at different levels of exercise involvement, making them practical for clinical and everyday use. This approach supports a translationally driven bench-to-bedside perspective, allowing for patient VO₂max assessment in virtually all settings.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.