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目的:探讨老年射血分数保留心力衰竭(心衰)患者的心肺运动试验特点及中间片段心房利钠肽原(MR-proANP)的临床价值。方法:前瞻性研究，连续选择2019年1—6月在郑州大学第五附属医院就诊的美国纽约心脏病协会(NYHA)心功能Ⅱ～Ⅲ级的老年射血分数保留心衰患者(心衰组)56例，同期体检的健康志愿者(对照组)49例，均进行心肺运动试验，在运动前静息时采集血浆并检测MR-proANP、N末端B型利钠肽原(NT-proBNP)的含量。结果:心衰组患者的NT-proBNP375(236～541)ng/L、MR-proANP 78(52～215)pmol/L的水平高于对照组的31(22～130)ng/L和14(10～23)pmol/L(n P<0.05)。心衰组患者中，心功能Ⅲ级(23例)患者MR-proANP水平228(121～436)pmol/L较心功能Ⅱ级(33例)患者60(50～92)pmol/L高(n χ2＝0.256，n P0.05)。心衰组患者的无氧阈、峰值氧摄取量、峰值氧摄取量占预计值的百分比、峰值氧脉搏较对照组降低(n P<0.05)，二氧化碳通气当量斜率升高(n P<0.05)；线性相关性分析提示，心衰组的MR-proANP、NT-proBNP与无氧阈、峰值氧摄取量、峰值氧摄取量占预计值的百分比、峰值氧脉搏均呈负相关(n P<0.05)，与二氧化碳通气当量斜率呈正相关(n P<0.05)，其中MR-proANP与峰值氧摄取量的相关强度(n r＝0.791)最高。n 结论:老年HFpEF患者的运动耐力和摄氧能力较健康人下降，心肺储备功能降低；心功能Ⅱ～Ⅲ级的射血分数保留心衰患者的血浆MR-proANP水平的高低可反映出心功能的水平。“,”Objective:To investigate the characteristics of cardiopulmonary exercise testing, and to explore the clinical value of midregional pro-atrial natriuretic peptide(MR-proANP)in elderly heart failure(HF)patients with preserved ejection fraction(HFpEF).Methods:A total of 56 elderly HFpEF patients with New York Heart Association(NYHA)cardiac function class Ⅱ-Ⅲ at our hospital from January 2019 to June 2019 were successively recruited into the HF group, and 49 healthy individuals who took health examinations during the same period were enrolled as the control group.All subjects underwent cardiopulmonary exercise testing.Plasma was collected at rest before exercise for the measurement of MR-proANP and N-terminal B-type natriuretic peptide(NT-proBNP).Results:NT-proBNP and MR-proANP levels were higher in the HF group than in the control group[375(236-541)ng/L n vs.31(22-130)ng/L, 78(52-215)pmol/L n vs.14(10-23)pmol/L, n P<0.05]. MR-proANP levels were higher in HF patients with NHYA class Ⅲ(n=23)than in HF patients with NHYA class Ⅱ(n=33)[228(121-436)pmol/Ln vs.60(50-92)pmol/L, n χ2=0.256, n P0.05]. Compared with the control group, the anaerobic threshold, peak exercise oxygen consumption(peak VOn 2), peak VOn 2 as percentage of predicted value(peak VO2%pred)and peak oxygen pulse were lower in the HF group(n P<0.05), and VE/VCOn 2 slope was higher in the HF group(n P<0.05). Pearson analysis showed that MR-proANP and NT-proBNP were negatively correlated with anaerobic threshold, peak VOn 2, peak VOn 2%pred, and peak oxygen pulse(n P<0.05), and positively correlated with the VE/VCOn 2 slope(n P<0.05). MR-proANP had the highest correlation with peak VOn 2(n r=0.791).n Conclusions:Compared with healthy subjects, exercise tolerance and oxygen uptake capacity are lower in elderly HFpEF patients, indicating that their cardiopulmonary reserve function is reduced, .Plasma levels of MR-proANP can reflect the state of cardiac function in HFpEF patients with NYHA class Ⅱ~Ⅲ and can better evaluate the condition of patients.