综合性运动训练预防前列腺癌患者雄激素剥夺疗法的副作用

Comprehensive exercise training prevents on side effects of androgen-deprivation therapy in patients with prostate cancer

目的:探讨在雄激素剥夺疗法(ADT)开始的同时进行综合运动干预能否降低前列腺癌患者ADT的副作用。方法:70例开始使用醋酸亮丙瑞林(lucrin)进行治疗的前列腺癌患者随机分为运动组和对照组,每组35例。运动组开展包括抗阻训练、有氧运动和冲击加载运动,每周3次,连续3个月。对照组不进行运动干预。在开始干预前(基线期)和干预后(3个月)评估患者身体组成成分、骨密度、身体机能、血生化指标和基于SF-36、QLQ-PR25、FACIT-Fatigue、BSI-18等量表评价的健康相关生活质量。采用协方差分析(ANCOVA)比较调整了组间差异后干预前后各变量的变化情况。结果:运动干预3个月后,与基线期相比较,试验组的四肢瘦体组织[x^(-) (95%CI):0.4(0.1~0.7)kg,P=0.029]和全身瘦体组织[x^(-) (95%CI):0.7(0.1~1.6)kg,P=0.054]在调整了组间差异后均有显著增加。而运动组全身脂肪量及其比例、躯干脂肪量在调整组间差异后均有降低(P<0.01或P<0.001)。与对照组比较,试验组患者的股骨颈变化值[x^(-) (95%CI):0.012(0.005~0.024)kg,P=0.032]、胫骨骨密度变化值[x^(-) (95%CI):20.0(12.5~29.5)kg,P=0.019]差异有统计学意义。与对照组比较,试验组在心肺功能(VO 2 peak)、上肢肌肉和下肢肌肉的最大力量(胸部推举、腿部推蹬和坐姿划船)、肢体功能(椅子起立试验)方面均有显著的改善(P<0.05或P<0.01)。两组间在行走能力、平衡能力和平衡信心方面得分差异无统计学意义(P>0.05)。组间总胆固醇/HDL比值差异有统计学意义(P=0.027)。干预后患者性功能和疲劳感也得到了改善。结论:当开始ADT的同时启动包括有氧运动、抗阻运动和冲击加载运动的综合性运动计划,可以改善患者身体成分、身体功能、总胆固醇/HDL比例、性功能、疲劳严重程度。本研究扩展了运动干预对于改善ADT治疗前列腺癌的副作用的有效性的证据。

Objective:To investigate whether combined exercise intervention at the beginning of androgen deprivation therapy(ADT)can reduce ADT side effects in patients with prostate cancer.Methods:70 prostate cancer patients who started treatment with Lucrin were randomly divided into exercise group and control group,35 patients in each group.The exercise group carried out resistance training,aerobic exercise and impact-loading exercise three times a week for three months.The control group did not receive any exercise intervention.Before(baseline period)and after intervention(3 months),patients'body composition,bone mineral density,body function,blood biochemical indicators and health-related quality of life were evaluated based on SF-36,QLQ-PR25,FACIT-fatigue,BSI-18 and other scales.Analysis of covariance(ANCOVA)was used to compare the changes of each variable before and after intervention after adjusting for inter-group differences.Results:After exercise intervention after 3 months,compared with the baseline period,patients limbs thin body organization[x^(-) (95%CI):0.4(0.1~0.7)kg,P=0.029]and whole body thin body organization[x^(-) (95%CI):0.7(0.1~1.6)kg,P=0.054]after adjusting for differences between groups were increased significantly.In the exercise group,total body fat mass and its proportion,as well as trunk fat mass,were decreased after adjusting for the differences between the groups(P<0.01 or P<0.001).Compared with control group,experimental group of patients with femoral neck change value[x^(-) (95%CI):0.012(0.005~0.024)kg,P=0.032],the tibia bone mineral density changes value[x^(-) (95%CI):20.0(12.5~29.5)kg,P=0.019]the difference was statistically significant.Compared with the control group,the experimental group showed significant improvement in cardiopulmonary function(VO 2 peak),maximum strength of upper and lower limb muscles(chest pushing,leg pushing and sitting rowing),and limb function(chair standing test)(P<0.05 or P<0.01).There was no significant difference in walking ability,balance ability and balance confidence between the two groups(P>0.05).The difference in total cholesterol/HDL ratio between the groups was statistically significant(P=0.027).Conclusion:A comprehensive exercise program including aerobic exercise,resistance exercise and impact loading exercise,when starting ADT,can improve patients'body composition,body function,total cholesterol/HDL ratio,sexual function,fatigue and psychological distress severity,as well as social function and mental health.This study expands the evidence for the effectiveness of exercise intervention in improving ADT in the treatment of prostate cancer.