摘要/Abstract

摘要： 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。
关键词: 乳腺癌, 新辅助化疗, 心肺运动试验, 峰值摄氧量, 体质量指数
Abstract:
Objective·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.
Methods·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.
Results·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.
Conclusion·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.

Key words: breast cancer, neoadjuvant chemotherapy, cardiopulmonary exercise testing (CPET), peak VO₂, body mass index (BMI)


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