关于心肺运动试验在冠心病诊断中的临床研究
Clinical Studies on the Cardiopulmonary Exercise Test in the Diagnosis of Coronary Heart Disease

背景与目的：冠心病是一种严重危害人类健康的疾病。目前临床常用的诊断方法有平板运动、冠状动脉 CT血管成像(CTA)、冠脉造影等，其中冠脉造影是诊断金标准，但却存在着有创等缺点。心肺运动试验作为一项无创、高效、安全的检测方法，在冠心病的诊断中越来越受到重视。我们的研究旨在明确CPET相关指标与冠脉狭窄程度之间的关系。方法：回顾性纳入2021年1月至2022年9月在青岛市立医院心脏中心冠脉造影(必要时行经皮冠状动脉支架植入术)前行心肺运动试验的患者共252例。根据冠状动脉造影结果及Gensini评分将患者分为低评分组(n = 218)及高评分组(n = 33)，记录并比较两组患者的基线资料及CPET相关指标。结果：高评分组患者的男性、年龄、BMI、吸烟史、高血压史、糖尿病史、白细胞计数、中性粒细胞计数、血小板计数、BNP、甘油三酯、总胆固醇、低密度脂蛋白以及D-二聚体水平均高于低评分组，高密度脂蛋白水平低于低评分组，差异均有统计学意义。高评分组患者的无氧阈公斤摄氧量、最大摄公斤摄氧量、无氧阈代谢当量、峰值代谢当量以及峰值氧脉搏均低于低评分组，差异均有统计学意义。结论：CPET对于冠心病的诊断具有较高价值，且相关指标可用于评估冠心病患者冠脉狭窄程度。
Background and Purpose: Coronary heart disease is a group of diseases that seriously endanger human health. The commonly used clinical diagnostic methods at present are platelet exercise, coronary CT angiography (CTA), coronary angiography, etc. Among them, coronary angiography is the diagnostic gold standard, but it has invasive and other shortcomings. Cardiopulmonary exercise test (CPET), as a non-invasive, efficient, and safe test, has been increasingly valued in the diagnosis of coronary artery disease. Our study aimed to clarify the relationship between CPET-related indexes and the degree of coronary stenosis. Methods: A total of 252 patients who underwent cardiopulmonary exercise testing before coronary angiography (percutaneous coronary stenting if necessary) at the Heart Centre of Qingdao Municipal Hospital from January 2021 to September 2022 were retrospectively included. Patients were divided into low-scoring group (n = 218) and high-scoring group (n = 33) according to coronary angiography results and Gensini score, the baseline data and CPET-related indexes of patients in the two groups were recorded and compared. Results: Male, age, BMI, smoking history, hypertension, diabetes mellitus, white blood cell count, neutrophil count, platelet count, BNP, triglyceride, total cholesterol, LDL, and D-dimer levels were higher in the high-scoring group than in the low-scoring group, and HDL levels were lower than in the low-scoring group, and the differences were statistically significant. The anaerobic threshold kilogram oxygen uptake, maximal kilogram oxygen uptake, anaerobic threshold metabolic equivalents, peak metabolic equivalents and peak oxygen pulse were lower in the high-scoring group than in the low-scoring group, and the differences were statistically significant. Conclusions: CPET is of high value for the diagnosis of coronary artery disease, and the related indexes can be used to assess the degree of coronary artery stenosis in