肺高血圧症患者における運動中の肺動脈圧と安静時血行動態および換気指標との関連性
背景 : 本研究の目的は，安静時の指標から肺高血圧症患者の運動中の肺循環動態悪化を予測する指標を明らかにすることである。 方法 : 2018年5月から2019年12月の間に当院へ右心カテーテル検査で入院した27例を対象に，mPAP-CO slopeが3以上を上昇群，3未満を非上昇群とし，安静時の指標との関連を検討した。 結果 : 分時換気量（オッズ比7.93, 95％CI 1.94-87.06, p＝0.001），収縮期肺動脈圧（オッズ比1.35, 95％CI 1.06-2.23, p＝0.007），VE/VCO2（オッズ比1.18, 95％CI 1.02-1.42, p＝0.012），R（オ...
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| Published in | 杏林医学会雑誌 Vol. 52; no. 4; pp. 167 - 176 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
杏林医学会
28.12.2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0368-5829 1349-886X |
| DOI | 10.11434/kyorinmed.52.167 |
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| Abstract | 背景 : 本研究の目的は，安静時の指標から肺高血圧症患者の運動中の肺循環動態悪化を予測する指標を明らかにすることである。 方法 : 2018年5月から2019年12月の間に当院へ右心カテーテル検査で入院した27例を対象に，mPAP-CO slopeが3以上を上昇群，3未満を非上昇群とし，安静時の指標との関連を検討した。 結果 : 分時換気量（オッズ比7.93, 95％CI 1.94-87.06, p＝0.001），収縮期肺動脈圧（オッズ比1.35, 95％CI 1.06-2.23, p＝0.007），VE/VCO2（オッズ比1.18, 95％CI 1.02-1.42, p＝0.012），R（オッズ比3.28, 95％CI 1.33-11.01, p＝0.046） が有意な項目であった。 結論 : 安静時の分時換気量，VE/VCO，収縮期肺動脈圧は運動中の肺動脈圧上昇を予測する因子であった。 |
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| AbstractList | 背景 : 本研究の目的は，安静時の指標から肺高血圧症患者の運動中の肺循環動態悪化を予測する指標を明らかにすることである。 方法 : 2018年5月から2019年12月の間に当院へ右心カテーテル検査で入院した27例を対象に，mPAP-CO slopeが3以上を上昇群，3未満を非上昇群とし，安静時の指標との関連を検討した。 結果 : 分時換気量（オッズ比7.93, 95％CI 1.94-87.06, p＝0.001），収縮期肺動脈圧（オッズ比1.35, 95％CI 1.06-2.23, p＝0.007），VE/VCO2（オッズ比1.18, 95％CI 1.02-1.42, p＝0.012），R（オッズ比3.28, 95％CI 1.33-11.01, p＝0.046） が有意な項目であった。 結論 : 安静時の分時換気量，VE/VCO，収縮期肺動脈圧は運動中の肺動脈圧上昇を予測する因子であった。 |
| Author | 飛田, 和基 児玉, 優太 木村, 雅彦 合田, あゆみ 岡島, 康友 |
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| ContentType | Journal Article |
| Copyright | 2021 杏林医学会 |
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| References | 21) Kovacs G, Herve P, Barbera JA, Chaouat A, Chemla D, Condliffe R, Garcia G, Grunig E, Howard L, Humbert M, Lau E, Laveneziana P, Lewis GD, Naeije R, Peacock A, Rosenkranz S, Saggar R, Ulrich S, Vizza D, Noordegraaf AV, Olschewski H : An official European Respiratory Society statement : Pulmonary haemodynamics during exercise. Eur Respir J 50(5), 2017. 4) Weinstein AA, Chin LMK, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG, Connors G, Chan L : Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med 107(5) : 778-784, 2013. 7) Ehlken N, Lichtblau M, Klose H, Weidenhammer J, Fischer C, Nechwatal R, Uiker S, Halank M, Olsson K, Seeger W, Gall H, Rosenkranz S, Wilkens H, Mertens D, Seyfarth HJ, Opitz C, Ulrich S, Egenlauf B, Grunig E : Exercise training improves peak oxygen consumption and hemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thromboembolic pulmonary hypertension A prospective, randomized, controlled trial. Eur Heart J 37(1) : 35-44, 2016. 26) Ho JE, Zern EK, Lau ES, Wooster L, Bailey CS, Cunnigham T, Eisan AS, Hardin KM, Farrell R, Sbarbaro JA, Schoenik MW, Houstis NE, Baggish AL, Shah RV, Nayor M, Malhotra R, Lewis GD : Exercise Pulmonary Hypertension Predicts Clinical Outcomes pulmonary hypertension predicts clinical outcomes in Patients With Dyspnea on Effort. J Am Coll Cardiol 75(1) : 17-26, 2020. 24) Lau EMT, Manes A, Celermajer DS, Galiè N : Early detection of pulmonary vascular disease in pulmonary arterial hypertension : Time to move forward. Eur Heart J 32 : 2489-2498, 2011. 3) Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winller J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E : Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 114(14) : 1482-1489, 2006. 18) Inagaki T, Terada J, Tanabe N, Kaawta N, Kasai H, Sugiura T, Shigeta A, Asano Y, Murata A, Tsushima K, Tada Y, Sakano S, Tatsumi K : Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension : A preliminary study. Respir Investig 52(6) : 357-364, 2014. 22) Kovacs G, Olschewski A, Berghold A, Olschewski H : Pulmonary vascular resistances during exercise in normal subjects : A systematic review. Eur Respir J 39(2) : 319-328, 2012. 5) Chan L, Chin LMK, Kennedy M, Woolstenhulme, Nathan SD, Weinstein AA, Connors G, Weir NA, Drinkard B, Lamberti J, Keyser RE : Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest 143(2) : 333-343, 2013. 1) Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Noordegraaf AV, Beghetti M, Ghofrani A, Sanchez MA, Hansmann G, Klepetko W, Lancelloti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M : 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J : 37(1) : 67-119, 2016. 6) Ley S, Fink C, Risse F, Ehlken N, Fischer C, Ley-Zaporoahan J, Kauczor HU, Klose H, Gruenig E : Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension. Eur Radiol 23(2) : 324-331, 2013. 10) Buys R, Avila A, Cornelissen VA : Exercise training improves physical fitness in patients with pulmonary arterial hypertension : A systematic review and meta-analysis of controlled trials. BMC Pulm Med 15(1) : 40, 2015. 25) Naeije R, Richter MJ, Rubin LJ : The physiologic basis of pulmonary arterial hypertension. Eur Respir J. 2021. 11) Pandey A, Garg S, Khunger M, Garg S, Kumbhani DJ, Chin KM, Berry JD : Efficacy and safety of exercise training in chronic pulmonary hypertension : Systematic review and meta-analysis. Circ Heart Fail 8(6) : 1032-1043, 2015. 2) Becker-Grünig T, Klose H, Ehlken N, Lichtblau M, Nagel C, Fischer C, Gorenflo M, Tieda H, Schrannz D, Hager A, Kaemmerer H, Miera O, Ulrich S, Speich R, Uilker S, Grunig E : Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. Int J Cardiol : 168(1) : 375-381, 2013. 14) Grünig E, Ehlken N, Ghofrani A, Staehler G, Meyer FJ, Juenger J, Opitz CF, Klose H, Wilkens H, Rosenkranz S, Olsvhewski H, Halank M : Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 81(5) : 394-401, 2011. 19) Ehlken N, Verduyn C, Tiede H, Staehler G, Karger G, Nechwatal R, Opits CF, Klose H, Wilkens H, Rosenkranz S, Halank M, Grunig E : Economic evaluation of exercise training in patients with pulmonary hypertension. Lung 192(3) : 359-366, 2014. 15) Nagel C, Prange F, Guth S, Herb J, Ehlken N, Fischer C, Reichenberger F, Rosenkranz S, Seyfarth HJ, Mayer E, Halank M, Grunig E : Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension. PLoS One 7(7) : 1-8, 2012. 13) Fukui S, Ogo T, Takaki H, Ueda J, Tsuji A, Morita Y, Kumasaka R, Arakawa T, Nakanishi M, Fukuda T, Yasuda S, Ogawa H, Nakanishi N, Goto Y : Efficacy of cardiac rehabilitation after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Heart 102(17) : 1403-1409, 2016. 16) Grünig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, Halank M, Fiscer C, Seyfarth HJ, Klose H, Meyer A, Sorichter S, Wilkens H, Rosenkranz S, Opitz C, Leuchte H, Karger G, Speich R, Nagel C : Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J 40(1) : 84-92, 2012. 17) Kabitz HJ, Bremer HC, Schwoerer A, Sonntag F, Walterspacher S, Walker DJ, Ehlken N, Staehler G, Windisch W, Grunig E : The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung 192(2) : 321-328, 2014. 12) Fox BD, Kassirer M, Weiss I, Raviv Y, Peled N, Shitrit D, Kramer MR : Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail 17(3) : 196-200, 2011. 9) Yuan P, Yuan XT, Sun XY, Pudasaini B, Liu JM, Hu QH : Exercise training for pulmonary hypertension : A systematic review and meta-analysis. Int J Cardiol 178 : 142-146, 2015. 8) González-Saiz L, Fiuza-Luces C, Sanchis-Gomar F, Santos-Lozano A, Quezada-Loaiza CA, Flox-Camacho A, Munguia-Izquierdo D, Ara I, Santallia A, Moran M, Sanz-Ayan P, Escribano-Subias P, Lusia A : Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension : The WHOLEi ＋ 12 trial. Int J Cardiol 231 : 277-283, 2017. 20) Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB : A short physical performance battery assessing lower extremity function : Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2), 1994. 23) Malenfant S, Brassard P, Paquette M, Le Blanc O, Chouinard A, Nadeau V, Allan PD, Tzeng YC, Simard S, Bonnet S, Provencher S : Compromised cerebrovascular regulation and cerebral oxygenation in pulmonary arterial hypertesion. J Am Heart Assoc 6(10), 2017. |
| References_xml | – reference: 1) Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Noordegraaf AV, Beghetti M, Ghofrani A, Sanchez MA, Hansmann G, Klepetko W, Lancelloti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M : 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J : 37(1) : 67-119, 2016. – reference: 2) Becker-Grünig T, Klose H, Ehlken N, Lichtblau M, Nagel C, Fischer C, Gorenflo M, Tieda H, Schrannz D, Hager A, Kaemmerer H, Miera O, Ulrich S, Speich R, Uilker S, Grunig E : Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. Int J Cardiol : 168(1) : 375-381, 2013. – reference: 6) Ley S, Fink C, Risse F, Ehlken N, Fischer C, Ley-Zaporoahan J, Kauczor HU, Klose H, Gruenig E : Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension. Eur Radiol 23(2) : 324-331, 2013. – reference: 26) Ho JE, Zern EK, Lau ES, Wooster L, Bailey CS, Cunnigham T, Eisan AS, Hardin KM, Farrell R, Sbarbaro JA, Schoenik MW, Houstis NE, Baggish AL, Shah RV, Nayor M, Malhotra R, Lewis GD : Exercise Pulmonary Hypertension Predicts Clinical Outcomes pulmonary hypertension predicts clinical outcomes in Patients With Dyspnea on Effort. J Am Coll Cardiol 75(1) : 17-26, 2020. – reference: 18) Inagaki T, Terada J, Tanabe N, Kaawta N, Kasai H, Sugiura T, Shigeta A, Asano Y, Murata A, Tsushima K, Tada Y, Sakano S, Tatsumi K : Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension : A preliminary study. Respir Investig 52(6) : 357-364, 2014. – reference: 23) Malenfant S, Brassard P, Paquette M, Le Blanc O, Chouinard A, Nadeau V, Allan PD, Tzeng YC, Simard S, Bonnet S, Provencher S : Compromised cerebrovascular regulation and cerebral oxygenation in pulmonary arterial hypertesion. J Am Heart Assoc 6(10), 2017. – reference: 7) Ehlken N, Lichtblau M, Klose H, Weidenhammer J, Fischer C, Nechwatal R, Uiker S, Halank M, Olsson K, Seeger W, Gall H, Rosenkranz S, Wilkens H, Mertens D, Seyfarth HJ, Opitz C, Ulrich S, Egenlauf B, Grunig E : Exercise training improves peak oxygen consumption and hemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thromboembolic pulmonary hypertension A prospective, randomized, controlled trial. Eur Heart J 37(1) : 35-44, 2016. – reference: 25) Naeije R, Richter MJ, Rubin LJ : The physiologic basis of pulmonary arterial hypertension. Eur Respir J. 2021. – reference: 19) Ehlken N, Verduyn C, Tiede H, Staehler G, Karger G, Nechwatal R, Opits CF, Klose H, Wilkens H, Rosenkranz S, Halank M, Grunig E : Economic evaluation of exercise training in patients with pulmonary hypertension. Lung 192(3) : 359-366, 2014. – reference: 5) Chan L, Chin LMK, Kennedy M, Woolstenhulme, Nathan SD, Weinstein AA, Connors G, Weir NA, Drinkard B, Lamberti J, Keyser RE : Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest 143(2) : 333-343, 2013. – reference: 11) Pandey A, Garg S, Khunger M, Garg S, Kumbhani DJ, Chin KM, Berry JD : Efficacy and safety of exercise training in chronic pulmonary hypertension : Systematic review and meta-analysis. Circ Heart Fail 8(6) : 1032-1043, 2015. – reference: 13) Fukui S, Ogo T, Takaki H, Ueda J, Tsuji A, Morita Y, Kumasaka R, Arakawa T, Nakanishi M, Fukuda T, Yasuda S, Ogawa H, Nakanishi N, Goto Y : Efficacy of cardiac rehabilitation after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Heart 102(17) : 1403-1409, 2016. – reference: 4) Weinstein AA, Chin LMK, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG, Connors G, Chan L : Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med 107(5) : 778-784, 2013. – reference: 10) Buys R, Avila A, Cornelissen VA : Exercise training improves physical fitness in patients with pulmonary arterial hypertension : A systematic review and meta-analysis of controlled trials. BMC Pulm Med 15(1) : 40, 2015. – reference: 22) Kovacs G, Olschewski A, Berghold A, Olschewski H : Pulmonary vascular resistances during exercise in normal subjects : A systematic review. Eur Respir J 39(2) : 319-328, 2012. – reference: 21) Kovacs G, Herve P, Barbera JA, Chaouat A, Chemla D, Condliffe R, Garcia G, Grunig E, Howard L, Humbert M, Lau E, Laveneziana P, Lewis GD, Naeije R, Peacock A, Rosenkranz S, Saggar R, Ulrich S, Vizza D, Noordegraaf AV, Olschewski H : An official European Respiratory Society statement : Pulmonary haemodynamics during exercise. Eur Respir J 50(5), 2017. – reference: 14) Grünig E, Ehlken N, Ghofrani A, Staehler G, Meyer FJ, Juenger J, Opitz CF, Klose H, Wilkens H, Rosenkranz S, Olsvhewski H, Halank M : Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 81(5) : 394-401, 2011. – reference: 3) Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winller J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E : Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 114(14) : 1482-1489, 2006. – reference: 8) González-Saiz L, Fiuza-Luces C, Sanchis-Gomar F, Santos-Lozano A, Quezada-Loaiza CA, Flox-Camacho A, Munguia-Izquierdo D, Ara I, Santallia A, Moran M, Sanz-Ayan P, Escribano-Subias P, Lusia A : Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension : The WHOLEi ＋ 12 trial. Int J Cardiol 231 : 277-283, 2017. – reference: 17) Kabitz HJ, Bremer HC, Schwoerer A, Sonntag F, Walterspacher S, Walker DJ, Ehlken N, Staehler G, Windisch W, Grunig E : The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung 192(2) : 321-328, 2014. – reference: 24) Lau EMT, Manes A, Celermajer DS, Galiè N : Early detection of pulmonary vascular disease in pulmonary arterial hypertension : Time to move forward. Eur Heart J 32 : 2489-2498, 2011. – reference: 16) Grünig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, Halank M, Fiscer C, Seyfarth HJ, Klose H, Meyer A, Sorichter S, Wilkens H, Rosenkranz S, Opitz C, Leuchte H, Karger G, Speich R, Nagel C : Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J 40(1) : 84-92, 2012. – reference: 9) Yuan P, Yuan XT, Sun XY, Pudasaini B, Liu JM, Hu QH : Exercise training for pulmonary hypertension : A systematic review and meta-analysis. Int J Cardiol 178 : 142-146, 2015. – reference: 12) Fox BD, Kassirer M, Weiss I, Raviv Y, Peled N, Shitrit D, Kramer MR : Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail 17(3) : 196-200, 2011. – reference: 15) Nagel C, Prange F, Guth S, Herb J, Ehlken N, Fischer C, Reichenberger F, Rosenkranz S, Seyfarth HJ, Mayer E, Halank M, Grunig E : Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension. PLoS One 7(7) : 1-8, 2012. – reference: 20) Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB : A short physical performance battery assessing lower extremity function : Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2), 1994. |
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| Title | 肺高血圧症患者における運動中の肺動脈圧と安静時血行動態および換気指標との関連性 |
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| ispartofPNX | 杏林医学会雑誌, 2021/12/28, Vol.52(4), pp.167-176 |
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