量化低氧血症合并纤维化间质性肺疾病患者在增量循环过程中的腿部肌肉脱氧

IF 1.3 4区医学 Q4 PHYSIOLOGY

Clinical Physiology and Functional Imaging Pub Date : 2022-12-29 DOI:10.1111/cpf.12809

Mathieu Marillier, Anne-Catherine Bernard, Samuel Verges, Onofre Moran-Mendoza, J. Alberto Neder

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引用次数: 1

摘要

背景:在纤维化间质性肺疾病(f-ILD)患者中，低氧血症和心脏循环异常可能损害相对于氧气需求的肌肉氧气(O2)输送，从而增加增量运动期间的氧气提取率。利用近红外光谱(NIRS)的脱氧血红蛋白浓度([hbb])的变化作为O2提取的代理，我们研究了一种简化的(双线性)方法，以前在心力衰竭中测试过，是否可以提供f-ILD肌肉脱氧的有用估计。方法25例患者(男性23例，72±8岁;20例特发性肺纤维化患者(预测肺一氧化碳弥散量= 44±11%)和12例年龄和性别匹配的健康对照者进行了渐进式循环至症状限制。通过近红外光谱(NIRS)评估股外侧肌[hbb]的变化，分析其与整个运动过程中的工作速率(WR)和氧气摄取的关系。结果患者的运动能力低于对照组(例如，峰值WR分别为67±18%和105±20%;p < 0.001)。[hbb]响应曲线呈典型的s型，呈现三个不同的阶段。与对照组相比，患者肌肉缺氧加剧的证据是:(i)运动中期[hbb]-WR斜率更陡(0.30±0.22 vs 0.11±0.08 μmol/W);p = 0.008)(第二阶段)，(ii)运动后[hbb]增加较多(p = 0.002)(第三阶段)。[hbb]-WR斜率越陡，峰值WR越低(r = -0.70)，腿部不适程度越高(r = 0.77;p < 0.001)。结论:这种在增量运动中解释[hbb]的实用方法可能有助于确定低氧血症f-ILD患者肌肉缺氧的严重程度及其干预措施的潜在影响。

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Quantifying leg muscle deoxygenation during incremental cycling in hypoxemic patients with fibrotic interstitial lung disease

Background

Hypoxaemia and cardiocirculatory abnormalities may impair muscle oxygen (O₂) delivery relative to O₂ requirements thereby increasing the rate of O₂ extraction during incremental exercise in fibrotic interstitial lung disease (f-ILD). Using changes in deoxyhaemoglobin concentration ([HHb]) by near-infrared spectroscopy (NIRS) as a proxy of O₂ extraction, we investigated whether a simplified (double-linear) approach, previously tested in heart failure, would provide useful estimates of muscle deoxygenation in f-ILD.

Methods

A total of 25 patients (23 men, 72 ± 8 years; 20 with idiopathic pulmonary fibrosis, lung diffusing capacity for carbon monoxide = 44 ± 11% predicted) and 12 age- and sex-matched healthy controls performed incremental cycling to symptom limitation. Changes in vastus lateralis [HHb] assessed by NIRS were analysed in relation to work rate (WR) and O₂ uptake throughout the exercise.

Results

Patients showed lower exercise capacity than controls (e.g., peak WR = 67 ± 18% vs. 105 ± 20% predicted, respectively; p < 0.001). The [HHb] response profile was typically S-shaped, presenting three distinct phases. Exacerbated muscle deoxygenation in patients versus controls was evidenced by: (i) a steeper mid-exercise [HHb]-WR slope (0.30 ± 0.22 vs. 0.11 ± 0.08 μmol/W; p = 0.008) (Phase 2), and (ii) a larger late-exercise increase in [HHb] (p = 0.002) (Phase 3). Steeper [HHb]-WR slope was associated with lower peak WR (r = –0.70) and greater leg discomfort (r = 0.77; p < 0.001) in f-ILD.

Conclusion

This practical approach to interpreting [HHb] during incremental exercise might prove useful to determine the severity of muscle deoxygenation and the potential effects of interventions thereof in hypoxemic patients with f-ILD.

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来源期刊

Clinical Physiology and Functional Imaging 医学-生理学

CiteScore

3.40

自引率

5.60%

发文量

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.