李丹,沈涛,赵威,徐顺霖,任川,高炜

• 1:北京大学第三医院心内科心血管分子生物学与调节肽卫健委重点实验室

摘要(Abstract)：

目的 探讨心肺运动试验（CPET）摄氧量恢复延迟（VO2RD）对经皮冠状动脉介入治疗（PCI）术后心电图运动试验阴性患者预后的影响。方法 回顾性分析北京大学第三医院2018年1月至2019年9月在PCI术后半年内行CPET且心电图运动试验阴性患者1268例，收集患者的临床资料、冠状动脉造影及介入操作资料、实验室检查、超声心动图及CPET检查结果。所有患者通过门诊或电话随访，记录患者不良心血管事件，包括死亡、心肌梗死、卒中、短暂性脑缺血发作、非计划再次PCI、周围血管介入治疗、不稳定型心绞痛和急性心力衰竭事件引起的住院。采用多因素Cox回归分析探讨CPET VO2RD是否影响PCI术后心电图运动试验阴性患者的预后。结果 1268例入选患者中完成随访1218例，失访50例，随访14(10,20)个月，共发生不良心血管事件105例（8.6%）。不良事件组年龄[（62.4±9.9）岁比（60.3±10.2）岁，P=0.020]、不完全血运重建比例（42.9%比31.6%,P=0.022）以及合并高脂血症比例（79.0%比68.0%,P=0.020）均显著高于无不良事件组；糖化血红蛋白值[（7.3±1.1）%比（6.6±1.2）%,P=0.001]、空腹血糖[（7.1±2.6）mmol/L比（6.5±1.9）mmol/L,P=0.010]及N末端B型脑钠肽前体[107.5(50.1,399.8)pg/ml比88.2(39.2,225.0)pg/ml,P=0.017]显著高于无不良事件组；峰值心率[（121±18）次/分比（126±20）次/分，P=0.012]、无氧阈心率[（99±12）次/分比（102±14）次/分，P=0.029]和峰值摄氧量[（17.3±4.7）ml/（min·kg）比（18.7±2.1）ml/（min·kg）,P=0.003]显著低于无不良事件组，二氧化碳通气当量斜率[（33.3±9.2）比（28.1±5.1）,P=0.001]和VO2RD[(21.4±4.5)s比（18.5±5.4）s,P=0.001]显著高于无不良事件组。多因素Cox回归分析显示VO2RD>20s(HR1.594,95%CI1.026～2.476,P=0.038)是PCI术后心电图运动试验阴性患者发生不良心血管事件的独立危险因素。结论 PCI术后心电图运动试验阴性的患者仍有一定的不良心血管事件发生风险，CPET恢复期指标VO2RD>20 s是此类患者发生不良心血管事件的独立预测因素。

关键词(KeyWords)： 心肺运动试验;摄氧量恢复延迟;经皮冠状动脉介入治疗;不良心血管事件

Abstract:

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基金项目(Foundation):

作者(Author): 李丹,沈涛,赵威,徐顺霖,任川,高炜

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