Characteristics of cardiopulmonary exercise test in patients with coronary heart disease and non-alcoholic fatty liver disease
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摘要: 目的 比较冠心病和冠心病合并非酒精性脂肪肝(NAFLD)患者心肺运动试验指标的特点，探讨NAFLD对冠心病患者心肺耐力的影响。方法 选取2018年3月—2022年3月于重庆医科大学附属第一医院心内科住院行心肺运动试验的慢性稳定期冠心病患者122例，其中61例合并NAFLD为NAFLD组，61例无脂肪肝为对照组，比较两组患者运动心肺核心指标的差异。结果 122例冠心病患者平均峰值公斤摄氧量(Peak VO2/kg)为(17.89±3.82) mL·kg-1·min-1，102例(83.6%)患者无氧阈下代谢当量(AT-METs) < 5 MET。其中NAFLD组Peak VO2/kg、无氧阈(AT)、AT-METs均低于对照组(均P < 0.05)。Spearman相关检验分析提示，NAFLD与Peak VO2/kg、AT、AT-MET均呈显著负相关(r=-0.331、-0.274、-0.266，均P < 0.01)。多元线性回归分析显示，NAFLD是冠心病患者心肺耐力下降的独立危险因素(P < 0.05)。结论 NAFLD合并冠心病患者的心肺功能下降显著。Abstract: Objective To compare the indexes of cardiopulmonary exercise test(CPET) between patients with coronary heart disease and patients with coronary heart disease complicated with non-alcoholic fatty liver disease(NAFLD), and to explore the effect of NAFLD on cardiopulmonary fitness in patients with coronary heart disease.Methods A total of 122 patients with stable coronary heart disease who were hospitalized in the Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University from March 2018 to March 2022 were selected. Among them, 61 cases with NAFLD were divided into the NAFLD group and 61 cases without NAFLD as the control group. The differences in the core indexes of CPET between the two groups were compared.Results The average Peak VO2/kg in 122 patients with coronary heart disease was(17.89±3.82) mL·kg-1·min-1, and the subthreshold metabolic equivalent(AT-METs) in 102 patients(83.6%) was lower than 5 MET. The Peak VO2/kg, anaerobic threshold(AT), and AT-METs in the NAFLD group were lower than those in the control group(all P < 0.05). Spearman correlation analysis showed that NAFLD was negatively correlated with PeakVO2/kg, AT, and AT-MET(r=-0.331, -0.274, -0.266, all P < 0.01). Multiple linear regression analysis showed that NAFLD was an independent risk factor for cardiopulmonary fitness in patients with coronary heart disease(P < 0.05).Conclusion Cardiopulmonary fitness is significantly decreased in patients with coronary heart disease complicated with NAFLD.
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表 1 一般基线资料比较
Table 1. Comparison of basic data
X±S, M(P25, P75) 项目 对照组(61例) NAFLD组(61例) P值 年龄/岁 62(55，68) 62(56，67) 0.896 男性/例(%) 41(67.2) 46(75.4) 0.212 吸烟/例(%) 31(50.8) 24(39.3) 0.275 身高/m 1.64±0.07 1.65±0.07 0.370 BMI/(kg·m-2) 23.44±2.31 25.75±2.57 < 0.001 高血压病史/例(%) 32(52.2) 44(72.1) 0.039 糖尿病史/例(%) 15(24.6) 22(6.1) 0.237 HbA1c/% 6.0(5.5，6.3) 6.1(5.7，6.9) 0.066 ALT/(U·L-1) 19(13，30) 26(20，37) 0.002 AST/(U·L-1) 20(16，23) 22(17，28) 0.062 TC/(mmol·L-1) 3.82(3.25，4.07) 4.19(3.60，4.58) 0.331 TG/(mmol·L-1) 1.21(0.92，1.65) 2.06(1.26，2.85) < 0.001 HDL-C/(mmol·L-1) 1.11(1.00，1.39) 0.98(0.86，1.16) < 0.001 LDL-C/(mmol·L-1) 2.21(1.68，3.13) 2.30(1.72，3.00) 0.967 白蛋白/(g·L-1) 43.39±3.61 44.03±3.64 0.332 血小板/(×109·L-1) 192(146，229) 200(174，245) 0.062 尿酸/(μmol·L-1) 346.69±85.91 362.30±91.07 0.332 LVEF/% 63(60，65) 64(62，66) 0.187 Gensini积分 9(5，12) 8(5，13) 0.918 冠心病药物使用/例(%) β受体阻断剂 33(54.1) 37(60.7) 0.583 ACEI/ARB 38(62.3) 46(75.4) 0.171 抗血小板药物 53(86.8) 55(90.2) 0.780 他汀类药物 51(83.6) 55(93.4) 0.424 
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表 2 CPET指标比较
Table 2. Comparison of CPET indexes
X±S 项目 对照组(61例) NAFLD(61例) 总体 P值 Peak VO2/(L·min-1) 1196.00±290.26 1172.00±298.46 1184.27±293.42 0.497 Peak VO2/kg/(mL·kg-1·min-1) 19.00±3.60 16.78±3.82 17.89±3.82 < 0.001 峰值氧脉搏/(mL·次-1) 9.32±2.25 9.44±2.04 9.37±2.14 0.726 AT/(mL·kg-1·min-1) 15.56±3.17 13.90±2.61 14.73±3.01 0.002 AT-METs/Mets 4.40±0.90 3.99±0.74 4.21±0.86 0.002 峰值功率/W 100.28±32.74 95.51±33.42 97.89±33.03 0.427 VE/VCO2 32.85±4.78 35.00±5.82 33.93±5.41 0.027 1 Mets=3.5 mL O2·kg-1·min-1。
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表 3 心肺耐力与相关临床及实验室指标的相关性
Table 3. Correlation between cardiopulmonary fitness and clinical and laboratory parameters
变量 NAFLD BMI TG HDL-C r P r P r P r P Peak VO2/kg -0.331 < 0.001 -0.220 0.015 -0.168 0.065 0.078 0.375 AT -0.274 0.002 -0.179 0.048 -0.230 0.010 0.224 0.013 AT-METs -0.266 0.003 -0.174 0.055 -0.229 0.011 0.226 0.012
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表 4 多元线性回归分析结果
Table 4. Multiple linear regression analysis results
变量 NAFLD HDL-C β P β P Peak VO2/kg -0.323 < 0.001 0.216 0.013 AT -0.213 0.019 0.247 0.008 AT-METs -0.273 0.025 0.246 0.009
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