Division of Pediatric Clinical Research, Department of Pediatrics, Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, Holtz Children's Hospital of the UM/Jackson Memorial Medical Center, Miami, Florida 33101, USA.
Pediatr Blood Cancer. 2013 Apr;60(4):663-8. doi: 10.1002/pbc.24410. Epub 2012 Dec 19.
Childhood cancer survivors may have premature symptomatic cardiovascular and non-cardiovascular diseases that contribute to reduced capacity for physical activity. Studies of exercise capacity and identification of risk factors for reduced capacity in survivors are limited.
We assessed maximal myocardial oxygen consumption (V(O(2)max), a measure of exercise capacity) in survivors at least 4 years after cancer diagnosis and sibling controls. We evaluated associations between V(O(2)max) and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity.
Of 72 survivors (mean age, 22 years; range, 8.0-40 years) and 32 siblings (mean age, 20.2 years; range, 8-46 years), about half were male. Mean time since diagnosis was 13.4 years (range, 4.5-31.6 years). In age- and sibling-pair adjusted analyses, V(O(2)max) was lower in survivors than siblings (males, 28.53 vs. 30.90 ml/kg/minute, P = 0.08; females, 19.81 vs. 23.40 ml/kg/minute, P = 0.03). In males, older age (P = 0.01), higher percent body fat (P < 0.001) and high or low left ventricular (LV) mass Z-scores (P = 0.03) predicted lower V(O(2)max). In females, older age (P < 0.001), methotrexate exposure (P = 0.01), and higher, but normal, LV load-dependent contractility (P = 0.02) predicted lower V(O(2)max).
Fitness for most survivors and controls was poor and generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower V(O(2)max) in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to exercise regularly with close monitoring.
儿童癌症幸存者可能会出现过早的心血管和非心血管症状性疾病，从而导致体力活动能力下降。对幸存者运动能力的研究和识别运动能力下降的危险因素的研究有限。
我们评估了癌症诊断后至少 4 年的幸存者及其兄弟姐妹对照组的最大心肌耗氧量（V（O（2）max），衡量运动能力）。我们评估了 V（O（2）max）与年龄、性别、治疗、心脏结构和功能、生物标志物、内分泌功能和体力活动之间的关系。
在 72 名幸存者（平均年龄 22 岁，范围 8.0-40 岁）和 32 名兄弟姐妹（平均年龄 20.2 岁，范围 8-46 岁）中，约一半为男性。诊断后的平均时间为 13.4 年（范围 4.5-31.6 年）。在年龄和兄弟姐妹配对调整分析中，幸存者的 V（O（2）max）低于兄弟姐妹（男性，28.53 与 30.90ml/kg/min，P=0.08；女性，19.81 与 23.40ml/kg/min，P=0.03）。在男性中，年龄较大（P=0.01）、体脂百分比较高（P<0.001）和左心室（LV）质量 Z 评分较高或较低（P=0.03）预测 V（O（2）max）较低。在女性中，年龄较大（P<0.001）、甲氨蝶呤暴露（P=0.01）和较高但正常的 LV 负荷依赖性收缩性（P=0.02）预测 V（O（2）max）较低。
大多数幸存者和对照组的健康状况较差，幸存者的健康状况普遍较差，尤其是女性。年龄较大、体脂百分比较高、甲氨蝶呤暴露以及 LV 质量/功能的极端情况与幸存者的 V（O（2）max）较低有关。由于体力活动可以改善营养和心脏状况，因此应鼓励幸存者定期进行锻炼，并密切监测。
