肌肉训练联合有氧运动对肺癌化疗后癌因性疲乏患者下丘脑-垂体-肾上腺皮质轴的影响

The effect of muscle training combined with aerobic exercise on the hypothalamic-pituitary-adrenal axis in patients with cancer-related fatigue after chemotherapy for lung cancer

目的探讨肌肉训练联合有氧运动对肺癌化疗后癌因性疲乏(CRF)患者下丘脑-垂体-肾上腺皮质(HPA)轴的影响。方法选取2018年1月至2019年12月浙江省台州医院胸外科门诊就诊的肺癌化疗后CRF患者84例,随机分为两组,每组各42例。单用组予肌肉训练治疗,联用组在单用组基础上加有氧运动,两组均干预12周。观察两组干预前后血清促肾上腺皮质激素(ACTH)和皮质醇(Cor)水平的变化,并比较临床效果。结果干预12周后,两组的血清ACTH水平[(63.17±9.26)ng/L、(52.76±7.45)ng/L]较干预前[(84.16±12.46)ng/L、(85.19±14.12)ng/L]明显下降,Cor水平[(126.49±18.15)ng/ml、(142.62±21.54)ng/ml]较干预前[(97.12±14.46)ng/ml、(98.26±13.87)ng/ml]明显上升(P<0.05或P<0.01),且联用组的变化幅度更明显(P<0.05);同时联用组的临床总有效率(95.24%)较单用组(80.95%)更佳(χ^(2)=4.091,P<0.05)。结论肌肉训练联合有氧运动用于肺癌化疗后CRF患者的效果确切,能明显降低CRF症状,其作用机制可能与通过抑制ACTH的分泌释放,促进Cor的分泌释放,起调节HPA轴功能紊乱的作用密切相关。

Objective To investigate the effect of muscle training combined with aerobic exercise on the hypothalamic-pituitary-adrenal(HPA)axis in patients with cancer-related fatigue(CRF)after chemotherapy for lung cancer.Methods A total of 84 lung cancer patients with CRF after chemotherapy were selected from January 2018 to December 2019 in the outpatient department of thoracic surgery of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University.They were randomly divided into two groups with 42 cases in each group.The single-therapy group was given muscle training therapy,while the combination group was supplemented with aerobic exercise on the basis of the same treatment as the single-therapy group.Both groups were intervened for 12 weeks.The changes of serum adrenocorticotropic hormone(ACTH)and cortisol(Cor)levels before and after intervention in the two groups were observed,and the clinical effects were compared between the two groups.Results The serum ACTH levels of the two groups after 12 weeks of intervention([63.17±9.26]ng/L,[52.76±7.45]ng/L)were significantly lower than those before intervention([84.16±12.46]ng/L,[85.19±14.12]ng/L).Meanwhile,Cor levels([126.49±18.15]ng/ml,[142.62±21.54]ng/ml)were significantly higher than those before intervention([97.12±14.46]ng/ml,[98.26±13.87]ng/ml)(P<0.05 or P<0.01),and the change range of the combination group was more significant(P<0.05).In addition,the total clinical effective rate in the combination group(95.24%)was better than(80.95%)in the single-therapy group(χ^(2)=4.091,P<0.05).Conclusion Muscle training combined with aerobic exercise shows definite effect for patients with CRF after chemotherapy for lung cancer,and can significantly relieve the symptoms of CRF.The mechanism of action may be closely related to regulating HPA axis dysfunction by inhibiting the secretion and release of ACTH and promoting the secretion and release of Cor.