应用心肺运动试验评估食管癌患者长期新辅助化疗前后整体功能的改变*

doi:10.12047/j.cjap.0079.2021.123

中国应用生理学杂志 ›› 2021, Vol. 37 ›› Issue (2): 189-194.doi: 10.12047/j.cjap.0079.2021.123

应用心肺运动试验评估食管癌患者长期新辅助化疗前后整体功能的改变^*

刘方¹, 孙兴国^1△, Curtis Hightower², 葛万刚¹

1.中国医学科学院阜外医院心血管疾病国家重点实验室,北京 100037,中国;
2.MD Anderson Cancer Center,Houston,USA

收稿日期:2020-08-12 修回日期:2021-03-15 出版日期:2021-03-28 发布日期:2021-10-20
通讯作者: ^△Tel：010-88398300;E-mail: xgsun@lundquist.org
基金资助:
^*国家高技术研究发展计划（863计划）课题资助项目（2012AA021009）; 国家自然科学基金医学科学部面上项目（81470204）; 中国康复医疗机构联合重大项目基金（20160102）; 中国医学科学院国家心血管病中心阜外医院科研开发启动基金（2012-YJR02）; 首都临床特色应用研究与成果推广（Z161100000516127）; 北京康复医院2019-2021科技发展专项（2019-003）; 北京协和医学院教学改革项目（2018E-JG07）; 北京协和医学院-国家外国专家局外国专家项目（2015,2016,T2017025,T2018046,G2019001660）; 重庆市卫计委医学科研计划项目（2017MSXM090）; 重庆市科委社会事业与民生保障科技创新专项项目（cstc2017shmsA130063）

Cardiopulmonary exercise testing was used to evaluate objectively and quantitatively the holistic function in patients after neoadjuvant chemotherapy

LIU Fang¹, SUN Xing-guo^1△, HIGHTOWER Curtis², GE Wan-gang¹

1. Fuwai Hospital National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease Clinical Medicine Research, Beijing 100037, China;
2. MD Anderson Cancer Center,Houston, USA

Received:2020-08-12 Revised:2021-03-15 Online:2021-03-28 Published:2021-10-20

摘要/Abstract

摘要： 目的: 用心肺运动试验（CPET）定量评估化疗对人体整体心肺功能状态的影响。方法: 本研究选取2006年至2007年在MD Anderson癌症中心进行外科手术前化疗的6例食管癌患者。对该6例患者分别行化疗前后最大症状限制性CPET的客观定量评估。结果: ①新辅助化疗前后CPET核心指标的变化：显著降低的核心指标有峰值摄氧量（Peak VO₂）（P<0.05）,无氧阈（AT）、峰值氧脉搏（Peak VO₂/HR）、摄氧通气效率峰值平台（OUEP）（P<0.01）,核心指标显著上升的有VE/VCO₂最小值、VE-vs-VCO₂斜率（P<0.05）。2化疗前后CPET循环指标的变化：患者静息状态及热身状态的VO₂无明显变化,AT （P<0.01）及Peak VO₂（P<0.05）均有下降。除静息及极限状态的下降不显著外,热身状态的摄氧通气效率（OUE）（P<0.05）及OUE@AT （P<0.01）呈现显著下降。四个状态的VE/ VCO₂均呈现上升趋势,但仅在热身状态的VE/ VCO₂ （P<0.05）及VE/ VCO₂@AT（P<0.01）有统计学意义。四个状态的VO₂ /HR均呈下降趋势,除VO₂/HR@AT（P<0.05）显著下降外,其他三个状态的变化尚无统计学差异。③化疗前后CPET通气指标的变化在整个运动过程中,除热身状态的PETCO₂（P<0.05）显著下降外,其余状态的PETCO₂呈现下降趋势,但尚无统计学差异。呼吸频率、每分通气量几乎无变化。患者四个状态的潮气量、VO₂/RF及VCO₂/RF均呈现下降趋势,但均无统计学差异。四个状态的PETO₂均呈现上升趋势,但无明显统计学差异。结论: 心肺运动试验可以从呼吸、循环、代谢等方面客观定量评估化疗前后机体功能状态的变化。

关键词: 心肺运动试验, 食管癌, 新辅助化疗, 功能状态, 客观定量评估

Abstract: Objective: Cardiopulmonary exercise testing(CPET)was used to evaluate objectively and quantitatively the holistic function in patients accepted preoperative chemotherapy. Methods: This study investigated reliable objective and quantitative assessment methods of symptom limited maximal incremental CPET before and after chemotherapy in patients with 6 esophageal cancer. We re-analyzed the changes in cardiopulmonary, metabolism, and other functions physiologic parameters of CPET. Results: After patients accepted preoperative chemotherapy,Peak oxygen consumption (Peak VO₂)(P<0.05), anaerobic threshold (AT) and peak oxygen pulse (Peak O₂paulse), oxygen uptake efficiency plateau (OUEP)were decreased (P<0.01). The lowest of ventilatory equivalent for carbon dioxide and slope of ventilatory equivalent for carbon dioxide were increased (P<0.05). For individual of all patients, except one patient's Peak VO₂ and OUEP slightly increased,all of the above indicators were reduced in the remaining patients. The lowest of ventilatory equivalent for carbon dioxide and slope of ventilatory equivalent for carbon dioxide increased in all the patients,except one patient's slope of ventilatory equivalent for carbon dioxide decreased slightly. The heart rate of 6 patients showed an upward trend in each state, but there was no statistical difference. Three of the 6 patients had blood pressure measurement, and the other 3 patients had a significant decrease in diastolic blood pressure (P<0.05) except at extreme state.The patients had lower oxygen uptake at AT(P<0. 01) and extreme state (P<0. 05) than that before chemotherapy. The oxygen uptake efficiency in a warm-up state(P<0. 01),and an AT state(P<0. 05)after chemotherapy were lower than those before chemotherapy. The ventilator equivalent for carbon dioxide after chemotherapy was in the each states presented an upward trend, but only ventilator equivalent for carbon dioxide after in the warm-up state (P<0.05) and AT(P<0.01) had statistical significance. oxygen pulse in all four states showed a decreasing trend, and only at AT (P<0.05) showed a significant decrease.After chemotherapy,the PETCO₂ in a warm-up state after chemotherapy was lower than that before chemotherapy(P<0. 05); the PETO₂in a quiescent state,a warm - up state,and an extreme state after chemotherapy were higher than those before chemotherapy;but there was nosignificant difference. Conclusion: The holistic functional capacity of patients with esophageal significantly decreased after 136 days chemotherapy. The circulatory functionalandentilator functional parameters significantly decreased after chemotherapy.

Key words: cardiopulmonary exercise testing, esophageal cancer, preoperative chemotherapy, holistic functional status, objective quantitative assessment

中图分类号:

R735.1

刘方, 孙兴国, Curtis Hightower, 葛万刚. 应用心肺运动试验评估食管癌患者长期新辅助化疗前后整体功能的改变^*[J]. 中国应用生理学杂志, 2021, 37(2): 189-194.

LIU Fang, SUN Xing-guo, HIGHTOWER Curtis, GE Wan-gang. Cardiopulmonary exercise testing was used to evaluate objectively and quantitatively the holistic function in patients after neoadjuvant chemotherapy[J]. CJAP, 2021, 37(2): 189-194.

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应用心肺运动试验评估食管癌患者长期新辅助化疗前后整体功能的改变^*

Cardiopulmonary exercise testing was used to evaluate objectively and quantitatively the holistic function in patients after neoadjuvant chemotherapy

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