收稿日期: 2021-08-04
网络出版日期: 2021-01-28
基金资助
国家自然科学基金(81971570);上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR2025B);上海市科学技术委员会优秀技术带头人计划(21XD143210);上海市科学技术委员会医学创新研究专项(20Y11910500);上海市浦东新区卫生和计划生育委员会联合攻关项目(PW2018D-03);上海交通大学“交大之星”计划医工交叉研究基金(YG2019ZDA13);上海理工大学医工交叉研究基金(10-20-302-425);上海市教育委员会高峰高原学科建设计划(20172014)
Assessment of cardiopulmonary exercise capacity in early stage of patients with breast cancer undergoing neoadjuvant chemotherapy and related factors
Received date: 2021-08-04
Online published: 2021-01-28
Supported by
National Natural Science Foundation of China(81971570);Shanghai Shenkang Hospital Development Center Three-year Action Plan: Promoting Clinical Skills and Innovation in Municipal Hospital(SHDC2020CR2025B);Advanced Technology Leader of Shanghai Science and Technology Committee(21XD143210);Innovation Research Project of Shanghai Science and Technology Commission(20Y11910500);Shanghai Pudong Municipal Health Commission-Joint Research Project(PW2018D-03);Medical-Engineering Cross Research of Shanghai Jiao Tong University(YG2019ZDA13);Medical-Engineering Cross Research of University of Shanghai for Science and Technology(10-20-302-425);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20172014)
目的·探究乳腺癌患者新辅助化疗早期的心肺功能和相关影响因素。方法·连续入选2020年9月—2021年5月在上海交通大学医学院附属仁济医院乳腺外科确诊的新发乳腺癌患者52例为化疗组，另选择与化疗组性别、年龄、体质量指数（body mass index， BMI）匹配的健康志愿者52例为对照组。化疗组完成新辅助化疗第一周期后，与对照组在心内科医师的监督下完成心肺运动试验（cardiopulmonary exercise testing，CPET）。收集并记录2组受试者的一般情况、血液学生物标志物、心电图、超声心动图等检查结果。结果·与对照组相比，化疗组的峰值摄氧量［（18.22±3.48） mL/（min·kg） vs （22.80±3.13） mL/（min·kg），P=0.000］、无氧阈［（12.09±2.35） mL/（min·kg） vs （14.93±2.60） mL/（min·kg），P=0.000］及氧脉搏［（7.67±1.45） mL/beat vs （8.87±1.29）mL/beat），P=0.000］明显降低。多元线性回归分析提示，乳腺癌患者新辅助化疗早期的BMI与其峰值摄氧量独立相关（β=-0.528，P=0.047）。结论·通过CPET发现乳腺癌患者在新辅助化疗早期已经出现心肺功能的下降；较高的BMI与患者峰值摄氧量的降低独立相关；通过降低体质量，将BMI维持在正常水平，可能有助于改善患者的心肺功能和心血管疾病远期预后。
柴烨子 , 马珺 , 江雯珑 , 刘启明 , 卢启帆 , 陶政宇 , 姜萌 , 卜军 . 乳腺癌患者新辅助化疗早期的心肺功能和相关影响因素研究[J]. 上海交通大学学报（医学版）, 2021 , 41(12) : 1643 -1648 . DOI: 10.3969/j.issn.1674-8115.2021.12.014
·To assess the cardiopulmonary exercise capacity in patients with breast cancer after neoadjuvant chemotherapy in the early stage and explore possible factors leading to the reduced functional tolerance in those patients.
·Fifty-two consecutive patients suffering from breast cancer and receiving neoadjuvant chemotherapy were included and completed cardiopulmonary exercise testing (CPET), laboratory tests, electrocardiograph and echocardiography after 1 cycle of chemotherapy in the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from September, 2020 to May, 2021. Fifty-two healthy age-, gender- and body mass index (BMI)-matched volunteers were enrolled and received CPET as the control group. The general conditions, hematological biomarkers, electrocardiogram and echocardiography of the subjects in the two groups were collected and recorded.
·Compared to the control group, the group of patients receiving neoadjuvant chemotherapy had reduced peak VO2 [(18.22±3.48) mL/(min·kg) vs (22.80±3.13) mL/(min·kg), P=0.000], anaerobic threshold [(12.09±2.35) mL/(min·kg) vs (14.93±2.60) mL/(min·kg), P=0.000] and oxygen pulse [(7.67±1.45) mL/beat vs (8.87±1.29) mL/beat), P=0.000]. On multivariable regression analysis, BMI was independently associated with peak VO2 (β=-0.528,P=0.047) of patients in the early stage of neoadjuvant chemotherapy.
·Decreased cardiopulmonary function could be detected in the early stage of neoadjuvant chemotherapy on patients with breast cancer via CPET. High BMI can be an independent predictor of the reduced peak VO2. Maintaining BMI at normal level by losing weight may help to improve patients' cardiopulmonary function and long-term cardiovascular prognosis.
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