癌因性疲乏与神经内分泌的相关性探讨及临床干预研究

A systematized research of the relationship between the neuroendocrine and cancer-related fatigue and clinical intervention for cancer-related fatigue

目的:初步探讨癌因性疲乏(CRF)与神经内分泌的相关性,并应用激素干预疗法进行治疗及相关性验证。方法:选取康复期肺癌患者进行研究。按照纳入及排除标准,最终纳入59例康复期肺癌患者,按照患者的CRF情况分为疲乏组(39例)和非疲乏组(20例)两组。利用多维疲乏症状量表-简化版(MFSI-SF)和疲劳症状量表(FSI)对所有患者进行调查,评估患者的CRF状况。采集所有纳入患者的清晨8:00静脉血,以电化学发光法检测患者血清皮质醇激素、血清甲状腺激素(T3,T4,FT3,FT4)及促甲状腺激素(TSH)的浓度;以酶联免疫吸附法检测血清中促肾上腺皮质激素(ACTH)的浓度。结果:疲乏组的血清皮质醇激素及血清甲状腺激素(T3,T4,FT3,FT4)浓度均低于非疲乏组,疲乏组的血清ACTH浓度高于非疲乏组,且组间差异均具有统计学意义(P<0.05),血清TSH浓度在两组间的差异无统计学意义(P>0.05)。对19例CRF患者激素补充治疗前后的相关指标进行对比。结果显示,激素补充干预后的血清皮质醇及甲状腺激素(T3,T4,FT3,FT4)浓度均高于干预前的水平,激素补充干预后的MFSI-SF评分及FSI评分明显低于干预前的评分,且自身前后对照的差异均有统计学意义(P<0.05)。结论:康复期肺癌患者的CRF与肾上腺轴及甲状腺轴的神经内分泌相关,疲乏患者的皮质醇及甲状腺激素的水平显著低于非疲乏患者。激素补充疗法能有效改善康复期肺癌患者的癌因性疲乏,但尚需大样本高质量的研究进一步验证。

Objective：To explore the relationship between cancer-related fatigue （CRF） and the neuroendocrine, and to perform exp- lorative treatment and correlation validation with hormone intervention. Methods：Convalescence patients with lung cancer were selected for research. According to include and exclude criterion, finally, a total of 59 cases of convalescence patients with lung cancer were included. Participants were divided into two groups, the fatigue group （with 39 cases ） and the non-fatigue group （with 20 cases ）. All patients were investigated with multidimensional fatigue symptom inventory-short form （MFSI-SF） and the fatigue symptom inventory （FSI） to assess the score of CRF. Serum specimens were collected at eight o＇clock a.m,which were examined according to enzyme-linked immunoadsordent assay for serum levels of corticotropin, and electrical ehemiluminescent immunoassay for serum levels of eortisol,thyroid hormone （ T3,T4, FT3, FT4 ） and thyrotropin hormone. Results ：The results demonstrated that fatigue group was associated with a lower serum concentration than non-fatigue group with respect to cortisol and thyroid hormone, and a higher serum concentration than non-fatigue group with respect to eorticotropin, and there were all significant difference（P〈0.05 ）. No significant difference was found between fatigue and non-fatigue groups with respect to serum levels of thyrotropin （P〉O.05）. We compared the relative indexes before and after hormone supplement for 19 CRF patients. According to the results, there were significant improvement of concentrations of serum cortisol and thyroid hormone （T3, T4, FT3, FT4） after hormone supplement; and there were significant reduction of scores of MFSI-SF and FSI after hormone supplement. All of the differences from comparison of before and after the intervention had statistical significance （P〈0.05）. Conclusion： There are biology correlations between CRF and the neuroendocrine of hypothalamic-pituitary-adrenal axis （HPA）or the hypothalamic-pituitary-thyroid axis （HPT） in convalescence patients with lung cancer. The levels of serum cortisol and thyroid hormone in fatigue group are significantly lower than non-fatigue group. Hormone supplement therapy can effectively improve the quality of life of lung cancer patients with CRF, but this condusion needs to be further validated by large samples and high quality studies.