肺功能检查在心力衰竭患者中的临床应用与研究进展

Clinical Application and Research Progress of Pulmonary Function Examination in Patients with Heart Failure

摘要: 随着人口老龄化加剧，全球心力衰竭(Heart Failure, HF)负担显著加重，我国患者超890万，但5年生存率不足50%，且临床上存在“心肺分离”的问题——HF指南暂未将肺功能检查纳入常规，而HF患者常伴有的呼吸困难、肺功能异常与HF的发生、发展密切相关。本文系统梳理HF患者肺功能异常的流行病学特征、肺功能检查在HF中的临床应用价值及异常肺功能对HF的双向作用机制。现有研究表明，HF患者肺功能异常率可高达60%以上，以限制型通气障碍为主，且为HF发病及不良预后的独立预测因子；肺功能检查可用于HF的诊断鉴别、病情评估、治疗监测及康复指导等方面，其异常机制涉及血流动力学异常、肺血管重构等多重环节。由此可见，肺功能检查对HF“心肺一体化”管理具有重要临床价值，需进一步推动其在HF诊疗中的规范化应用，并探索相关干预策略以改善患者预后。

Abstract: With the intensification of population aging, the global burden of heart failure (HF) has increased significantly. The number of HF patients in China exceeds 8.9 million, yet the 5-year survival rate is less than 50%. Clinically, there exists a problem of “cardiopulmonary dissociation”—HF guidelines have not yet incorporated pulmonary function tests (PFTs) into routine practice, while dyspnea and abnormal pulmonary function, which are frequently observed in HF patients, are closely associated with the onset and progression of HF. This article systematically reviews the epidemiological characteristics of abnormal pulmonary function in HF patients, the clinical application value of PFTs in HF, and the bidirectional mechanism of action between abnormal pulmonary function and HF. Existing studies have shown that the prevalence of abnormal pulmonary function in HF patients can be as high as over 60%, mainly dominated by restrictive ventilatory dysfunction, and it serves as an independent predictor of HF incidence and adverse prognosis. PFTs can be applied in diagnostic differentiation, disease severity assessment, treatment monitoring, and rehabilitation guidance of HF, with the underlying mechanisms of pulmonary function abnormalities involving multiple links such as hemodynamic abnormalities and pulmonary vascular remodeling. Thus, PFTs hold significant clinical value for the “integrated cardiopulmonary management” of HF. It is necessary to further promote the standardized application of PFTs in the diagnosis and treatment of HF and explore relevant intervention strategies to improve patient prognosis.