男性非小细胞肺癌合并慢性阻塞性肺疾病患者运动耐量、通气效率特点临床研究

关键词：非小细胞肺癌  慢性阻塞性肺疾病  心肺运动试验  运动耐量  通气效率

Keywords:non-small cell lung cancer  chronic obstructive pulmonary disease  cardiopulmonary exercise testing  exercise tolerance  ventilatory efficiency

摘要：

      摘要 目的：观察男性非小细胞肺癌（NSCLC）合并慢性阻塞性肺疾病（COPD）患者运动耐量及通气效率特点。 方法：将32例男性NSCLC患者根据是否合并COPD分为NSCLC合并COPD组（NSCLC-COPD组，n=12）和未合并COPD组（NSCLC-non COPD组，n=20），以同期行心肺运动试验（CPET）的健康体检者为对照组（n=20）。所有NSCLC患者在肺切除术前完成症状限制性最大负荷运动测试，对CPET结果进行比较分析。 结果：与对照组比较，NSCLC-non COPD组与NSCLC-COPD组的峰值摄氧量（VO2peak）、峰值摄氧量/预计值（VO2peak/pred%）、峰值公斤摄氧量（peak VO2/kg）、无氧阈（AT）均下降（均P<0.05），二氧化碳通气当量斜率（VE/VCO2slope）、二氧化碳通气当量最低值（VE/VCO2nadir）均上升（均P<0.05），且NSCLC-COPD组VE/VCO2slope、VE/VCO2nadir均高于NSCLC-non COPD组（P<0.05）。与对照组和NSCLC-non COPD组相比，NSCLC-COPD组在测试的不同状态下（静息、热身、无氧阈时、峰值时）VE/VCO2均上升（P<0.05）。而与对照组相比，NSCLC-non COPD组在无氧阈时、峰值时VE/VCO2的上升才有显著性差异（均P<0.05）。NSCLC-COPD组潮气末二氧化碳分压（PETCO2）四个阶段均低于对照组（P<0.05），在峰值运动时，与NSCLC-non COPD组比较有显著性差异（P<0.05）。 结论：与健康人群比较，NSCLC患者运动耐量减损，且合并COPD的NSCLC患者整个运动阶段通气效率显著下降，单纯肺癌患者未见此特点。CPET可为NSCLC-COPD患者肺切除术前的风险评估提供依据。

Abstract:

      Abstract Objective： To explore the characteristics of aerobic exercise tolerance and ventilatory efficiency during cardiopulmonary exercise testing (CPET) among the male patients with non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). Method： A total of 32 NSCLC patients and 20 healthy controls were enrolled in this study. NSCLC patients were divided into NSCLC-COPD group (n=12) and NSCLC-non-COPD group (n=20). All NSCLC patients conducted symptom-limited maximum CPET before pneumonectomy， and the results were compared and analyzed. Result： Compared with control group，NSCLC-non COPD group and NSCLC-COPD group had lower peak VO2，peak VO2/predicted，peak VO2/kg and anaerobic threshold (AT)(all P<0.05)，as well as higher VE/VCO2slope and VE/VCO2nadir. When compared with NSCLC-non COPD group, NSCLC-COPD group had lower VO2 and higher VE/VCO2 values(P<0.05). Compared with control group and NSCLC-non COPD group，VE/VCO2 values in different exercise stages of NSCLC-COPD group were significantly higher(all P<0.05). Significant difference was also found in VE/VCO2 values at AT and peak exercise between control group and NSCLC-non COPD group(all P<0.05). Compared with control group， partial pressure of end-tidal carbon dioxide （PETCO2）values in four stages of NSCLC-COPD group were markedly lower(all P<0.05). Significant difference also existed in PETCO2 at peak exercise between NSCLC-COPD group and NSCLC-non COPD group (P<0.05). Conclusion： Compared with healthy subjects， exercise tolerance of NSCLC patients is slightly impaired and ventilation efficiency of NSCLC-COPD patients is significantly decreased but not in NSCLC-non COPD group. CPET can provide a basis for risk assessment of NSCLC-COPD patients before pneumonectomy.