Cardiopulmonary responses to exercise in women with sickle cell anemia
Cardiopulmonary responses to exercise in women with sickle cell anemia
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DOI：
10.1164/rccm.2002036
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发表时间：
2002-05-01
影响因子：
24.7
通讯作者：
Gutin, B
中科院分区：
文献类型：
--
作者：
Callahan, LA;Woods, KF;Gutin, B
多种因素导致镰状细胞性贫血患者运动不耐受，但关于最大心肺运动试验（CPET）的安全性或这些患者运动受限的机制的信息很少。本研究报告的目的就是审查这些问题。17名患有镰状细胞性贫血的成年女性使用踏车测力计和斜坡协议进行了限制性最大CPET;每2分钟测量一次血气和乳酸浓度。所有患者均完成CPET，无并发症。没有患者表现出对运动的机械限制或心肌缺血的证据。然而，我们观察到三种病理生理模式的反应，这些患者的运动。11例患者的氧分压峰值（V）较低，无氧阈值（AT）较低，气体交换异常，呼吸储备较高;这种模式与该患者亚组中肺血管疾病导致的运动受限一致。3例患者的氧分压峰值（V）较低，AT较低，无气体交换异常，心率储备较高，与外周血管疾病和/或肌病一致。其余3例患者的氧分压峰值（V）较低，AT较低，无气体交换异常，心率储备较低;这种运动受限的模式最好用贫血解释。
Multiple factors contribute to exercise intolerance in patients with sickle cell anemia, but little information exists regarding the safety of maximal cardiopulmonary exercise testing (CPET) or the mechanisms of exercise limitation in these patients. The purpose of the present study was to examine these issues. Seventeen adult women with sickle cell anemia underwent symptom-limited maximal CPET using cycle ergometry and ramp protocols; blood gases and lactate concentrations were measured every 2 minutes. All patients completed CPET without complications. No patient demonstrated a mechanical ventilatory limitation to exercise or had evidence of myocardial ischemia. However, we observed three pathophysiologic patterns of response to exercise in these patients. Eleven patients had low peak (V) over dot O-2, low anaerobic threshold (AT), gas exchange abnormalities, and high ventilatory reserve; this pattern is consistent with exercise limitation due to pulmonary vascular disease in this patient subgroup. Three patients had low peak (V) over dot O-2, low AT, no gas exchange abnormalities, and a high heart rate reserve, a pattern consistent with peripheral vascular disease and/or a myopathy. The remaining three patients had low peak (V) over dot O-2, low AT, no gas exchange abnormalities, and a low heart rate reserve; this pattern of exercise limitation is best explained by anemia.