Arzu ERTEM CENGİZ, Funda COŞKUN, Ahmet URSAVAŞ

KOAH ve Overlap Sendromlu Hastalarda Kardiyopulmoner Egzersiz Testinin Değerlendirilmesi

Kronik Obstrüktif Akciğer Hastalığı (KOAH) sistemik inflamasyon ile seyreden bir hastalıktır ve sistemik inflamasyon KOAH’ta morbidite ve mortalitenin ana nedenidir. OSAS ve KOAH birlikteliği yani Overlap Sendromu (OS) toplumda % 1 sıklığında görülmektedir. Bu iki hastalığın birlikteliğinde sistemik inflamasyon şiddeti daha da artmaktadır. Bu nedenle de OS’lı hastalarda morbidite ve mortalite daha fazla oranda görülmektedir. Bu çalışmanın amacı KOAH ve OS’li hastalarda kardiyopulmoner egzersiz testleri arasında anlamlı farklılık olup olmadığını saptamaktı. Çalışmamızda 18 hastaya Kardiyopulmoner Egzersiz Testi (KPET) yapılmıştır. Test yapılan hastaların 12’si KOAH’lı ve 6’sı OS’lu idi. Çalışmaya alınan hastalara Vmax Encore, USA cihazı kullanılarak semptom sınırlı incremental KPET uygulandı. KPET sonucu maksimum oksijen tüketimi (VO2max ml/kg/min) KOAH’lı grupta 15,5 ±6,4, OS’lı grupta 12,4±6 saptandı. Bu açıdan anlamlı fark yoktu (P>0,05). Karbondioksit üretimi (VCO2 L/min) açısıdan da iki grup arasında anlamlı fark saptanmadı (p>0,05). Maksimum iş kapasitesi (work-watt) KOAH’lı grupta 59,2±29, OS’lı grupta 45,8±19 saptadı. Bu değerler arasında da anlamlı fark saptanmadı (p>0,05). Hastaların maksimum kalp hızı dakikada KOAH’lı grupta 120±21 ,OS’lı grupta 116±18 olarak saptandı. Oksijen pulse değeri (ml/atım) ve maksimum kalp hızı açısından İki grup karşılaştırmasında anlamlı fark yoktu (p>0,05) .Maksimum ventilasyon oranı (VEmax-L/dk) KOAH’lı grupta 43±13, OS’lı grupta 36,6±9,2 olarak saptadı. İki grup arasında anlamı fark saptanmadı (p>0,05). Endtidal CO2 değeri ve Endtidal O2 değeri açısında KOAH’lı ve OS’lı grup karşılaştırıldığında anlamlı fark saptanmadı (p >0,05) . Solunum katsayısı yani RQ oranı KOAH’lı grupta 1,1 ±0,4 iken OS’lı grupta 1,1±0,4 saptandı. İki grupta anlamlı fark yoktu. Anaerobik treeshot (AT) değeri KOAH’lı ve OS’lı grupta benzerdi. Bu değerler arasında da istatistiksel anlamlı fark saptanmadı (p>0,05). Sonuç olarak değerlendirildiğinde KOAH ve OS’lu hastalarda KPET değerlerini normal popülasyona göre düşük saptamakla birlikte iki hastalık arasında anlamlı farklılık saptamadık.

Anahtar Kelimeler:

KOAH, Overlap Sendromu, KPET

Comparison of Cardiopulmonary Exercise Tests for Patients with COPD and Overlap Syndrome

Chronic Obstructive Pulmonary Disease (COPD) is a disease that progresses through inflammation and the main reason for morbidity in COPD is this inflammation. The rate of appearance of OS (Overlap Syndrome) and COPD together is %1 in the general public. Systemic inflammation increases the severity even more when the two diseases appear together. This is why the morbidity and mortality rates are higher with patients diagnosed with OS. The purpose of this study is to find out whether there is a significant difference between the cardiopulmonary exercise test results for patients with the COPD and Overlap Syndrome (OS). 18 patients were subjected to Cardiopulmonary Exercise Tests (CPET) within the scope of the study. 12 of the patients were diagnosed with COPD and 6 of them with OS. A symptom-limited incremental CPET was performed using a Vmax Encore, USA device. Informed consent was obtained from all subjects. The results of the CPET revealed that the maximum oxygen consumption (VO2max ml/kg/min) in the group of patients with COPD was 15,5 ±6,4, and 12,4±6 in the group with OS. There was no significant difference in that sense (p>0,05). There was also no significant difference in carbon dioxide outturn between the two groups (VCO2 L/min) (p>0,05). The maximum work-watt in the group of patients with COPD was 59,2±29, and 45,8±19 in the group with OS. There also was no significant difference between these results (p>0,05). The maximum throb of the group of patients diagnosed with COPD was 120±21, and 116±18 in the group with OS. The comparison of Oxygen pulse value (ml/Pulse) and maximum throb did not show any significant difference either (p>0,05). The maximum ventilation rate (VEmax-L/min) in the group of patients with COPD was 43±13, and 36,6±9,2 in the group with OS. No significant difference was found between the two groups. (p>0,05). End-tidal CO2 values and end-tidal O2 values did not show any significant difference either. When compared (p >0,05). The respiratory quotient RQ in the group with COPD was 1,1 ±0,4 whereas in the group with OS the value was 1,1±0,4. No significant difference. The anaerobic thresold (AT) values in both groups were similar. No statistically significant difference was found between these two values either. (p>0,05). Although the CPET values of patients diagnosed with COPD and OSD were below the general population, there were no significant differences between the two diseases.

Keywords:

COPD, Overlap Syndrome, CPET,

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