肿瘤侵及血管对肺癌患者运动心肺功能的影响

Effect of tumor vascular invasion upon cardio-pulmonary exercise functions in patients with lung cancer

目的探讨肿瘤侵及血管与肺癌患者运动心肺功能改变之间的相关性。方法对405例肺癌患者（经CT或手术证实无血管受侵者112例，有血管受侵者293例）行运动心肺功能测定，主要观察指标为终止负荷运动时最大运动负荷占预计值百分比（W％）、最大千克摄氧黾（VO2／kg）、无氧阈（AT）、最大氧脉搏实测值占预计值百分比（VO3／HR％）、最大通气量（VE）、最大呼吸储备（BR）、最快呼吸频率（BF）和最大呼气潮气量（VTex）。结果血管受侵患者W％、VO2／kg、AT、VO2／HR％[分别为（73±18）％、（17±5）ml·min^-1·k^-1、（51±14）％、（79±18）％）]明显低于无血管侵犯患者[分别为（86±20）％、（19±5）ml·min·kg^-1、（55±14）％、（88±20）％，均P〈0．01]，BF明显高于无血管受侵患者[（32．1±6．1）比（30．6±5．1）次／min，P〈0．05]。将血管受侵患者按TNM分期、受侵血管数目、种类及其与肿瘤的关系等分别分组进行比较，发现受侵血管为1、2、≥3支的患者W％、VO2／HR％均明显低于对照组（均P〈0．01），1支组和≥3支组AT明显低于对照组（P〈0．05，P〈0．01）；2支组和≥3支组VO2／kg明硅低于对照绀（P〈0．05，P〈0．01）；≥3支组VO2／kg明显低于1支组和2支绀（P〈0．05或P〈0．01），VO2／HR％明显低于1支组（P〈0．05），VTex低于对照组和1支组（P〈0．05）。VO2／HR％与受侵血管支数有相关忡（r=0．220，P〈0．01）。结论有血管受侵的肺癌患者摄氧量、运动能力、运动心功能降低，受累血管数目是影响患者运动心肺功能的主要原因。

Objective To investigate the correlation between the tumor vascular invasion and the change of cardio-puhnonary exercise function in patients with tung cancer. Methods The cardio-pulmonary exercise test was performed in 405 patients with lung cancer （293 with vascular invasion and 112 without）. The peak load indices examined included maximal work power （ measured value/predicted value, W% ） , maximal oxygen uptake per weight （ VOe/kg） , anaerobic threshold （ AT）, maximal oxygen pulse （ measured value/predicted value, VO2/HR% ）, maximal minute ventilation （VE）, maximal breath reserve （BR）, maximal breath frequency（BF） and maximal tidal volume dining expiration （VTex）. Results （ 1 ） W%, VO2/kg, AT, VO2/HR% of patients with vascular invasion [ （73 ± 18 ） % , （ 17 ±5 ） ml · min ^-1 · kg^-1, （51 ± 14） %, （79 ± 18 ） % respectively ] decreased than those without vascular invasion [ （ 86 ± 20） %, （19±5） ml· min^-1 · kg^-1, （55±14）%, （88 ±20）% respectively, all P〈0.01） while BF increased [ （32.1 ± 6. 1 ）/min vs （30. 6 ± 5.1 ）/min, P 〈 0. 05 ）. （2） The patients were divided according to TNM stage, number, kind of tumor vascular invasion and its relationship with tumor, W% ,VO2/HR% decreased in the groups of 1-, 2- and ≥3-vessel invasion versus the control group （P 〈0. 01 ）, AT decreased in the groups of 1- and ≥3-vessel invasion versus the control group （ P 〈0. 05, P 〈0. 01 ） , VO2/kg decreased in the groups of 2- and ≥3-vessel invasion versus the control group （ P 〈0. 05, P 〈0. 01 ） , VO2/kg decreased in the group of ≥3-vessel invasion versus 1- and 2-vessel invasion （P 〈0. 05 or P 〈0. 01 ） , VO2/HR% decreased in the gronp of ≥3-vessel invasion versus 1-vessel invasion （P 〈 0. 01 ）, VTex decreased in the group of ≥ 3-vessel invasion versus the control group and 1-vessel invasion （P 〈 0. 05 ）. There was correlation between V O2/HR% and the number of tumor invaded vessels （r = 0. 220, P 〈 0. 01 ）. Conclusions The amount of oxygen uptake, exercise ability and cardiac function during exercise decrease in patients of lung cancer with tumor vascular invasion. The main reason is the number of the invaded vessels.