不同吸烟状态肺癌男性通气效率与运动耐量的临床研究

关键词：吸烟状况  肺癌  心肺运动试验  通气效率  运动耐量

Keywords:smoking status  lung cancer  cardiopulmonary exercise test  ventilation efficiency  exercise tolerance

摘要：

      摘要 目的：利用心肺运动试验（CPET）比较不同吸烟状态肺癌男性的通气效率与运动耐量。 方法：选取2020年7月—2022年8月于徐州市中心医院胸外科首次住院的88例男性肺癌患者，按术前吸烟状态分为不吸烟组（non-smoke组，n=23）、吸烟组（ongoing-smoke组，n=23）、近期戒烟组（recent-quit组，戒烟时间≤4m， n=19）和既往戒烟组（past-quit组，戒烟时间>4m， n=23）。所有患者在肺切除术前完成症状限制性最大负荷运动测试，并对CPET结果进行比较分析。 结果：与non-smoke组相比，ongoing-smoke组、recent-quit组无氧阈（AT）、最大代谢当量（METpeak）、最大功率（WRpeak）、峰值摄氧量（VO2peak）、峰值摄氧量/预计值（VO2peak/pred）、峰值公斤摄氧量（peakVO2/kg）均下降（P<0.05）；与ongoing-smoke组相比，recent-quit组、past-quit组METpeak、VO2peak/pred、peakVO2/kg较优（P<0.05），past-quit组AT、METpeak、WRpeak、VO2peak较优（P<0.01）；与recent-quit组相比，past-quit组VO2peak较优（P<0.05）。与non-smoke组相比，ongoing-smoke组在AT、峰值时的VCO2、VO2、VE、O2pulse、VE/VCO2均降低（P<0.05），recent-quit组在AT时的VCO2、VO2、VE降低（P<0.05）；与ongoing-smoke组相比，recent-quit组在AT、峰值时的VE/VCO2较低（P<0.05），AT时的PETCO2较优（P<0.05），且静息时的O2 pulse较高（P<0.05），past-quit组热身、AT、峰值时的VO2、O2 pulse较高（P<0.05），AT、峰值时的VCO2、VE较高（P<0.05），VE/VCO2较低（P<0.05）；与recent-quit组相比，past-quit组AT时VCO2较高（P<0.01），AT、峰值时VO2较高（P<0.05）。ongoing-smoke组在1—4min心率恢复低于non-smoke组与recent-quit组，在3—4min的差异有显著性意义（P<0.05）。 结论：与不吸烟的肺癌患者相比，吸烟者运动耐量及通气效率均下降，戒烟对于运动耐力及通气效率有所改善，且存在时间依赖。CPET可为吸烟肺癌患者肺切除术前的风险评估提供依据。

Abstract:

      Abstract Objective： To explore the clinical characteristics of exercise tolerance and ventilation efficiency in male lung cancer patients with different smoking statuses using cardiopulmonary exercise testing (CPET). Method： A total of eighty-eight male patients with lung cancer who were hospitalized for the first time in the Department of Thoracic Surgery， Xuzhou Central Hospital from July 2020 to August 2022 were included and divided into non-smoke group （n=23）， ongoing-smoke group（n=23）， recent quit group （smoking cessation time≤4m， n=19） and past quit group （smoking cessation time>4m， n=23） before surgery. All patients completed symptom-limited maximal load exercise test after pulmonary resection， and the results of CPET were compared and analyzed. Result： Compared with the non-smoke group， the ongoing-smoke and recent-quit group showed decreases in anaerobic threshold （AT）， peak metabolic equivalent （METpeak）， peak work rate （WRpeak）， peak oxygen uptake （VO2peak）， peak oxygen uptake/estimated value （VO2peak/pred）， and peak oxygen uptake/kg （PeakVO2/kg） in decreased（P<0.05）. Compared with ongoing-smoke group， METpeak， VO2peak/pred and Peak VO2/kg （P<0.05）, and the past-quit groups had better AT， METpeak， WRpeak and VO2peak（P<0.01）. Compared with the recent-quit group， the past-quit group had a higher VO2peak（P<0.05）. Compared with non-smoke group， the ongoing-smoke group had lower VCO2， VO2， VE， O2 pulse and VE/VCO2 at AT and peak exercise （P<0.05）， and the recent-quit group had lower VCO2， VO2 and VE at AT exercise （P<0.05）. Compared with ongoing-smoke group， the recent-quit group had lower VE/VCO2 at AT and peak exercise（P<0.05）, better PETCO2 at AT exercise was better （P<0.05）， and higher O2 pulse at resting（P<0.05）. In the past-quit group， the VO2 and O2 pulse at warm-up， AT and peak exercise were higher （P<0.05）， the VCO2 and VE at AT and peak exercise were higher （P<0.05）， and the VE/VCO2 were lower （P<0.05）. Compared with the recent-quit group， VCO2 of the past-quit group was higher at AT exercise （P<0.01）， and the VO2 of the past-quit group was higher at AT and peak exercise （P<0.05）. Compared with non-smoke group and recent-quit group， the heart rate recovery of ongoing-smoke group slowed down in 1—4min， with statistical significance only in 3—4min （P<0.05）. Conclusion： Compared with non-smoking lung cancer patients， exercise tolerance and ventilation efficiency of smokers are decreased. Quitting smoking can improve exercise endurance and ventilation efficiency， and it is time-dependent. CPET can provide a basis for risk assessment of smoking lung cancer patients before lung resection.