Guinan Emer M, Connolly Elizabeth M, Healy Laura A, Carroll Paul A, Kennedy M John, Hussey Juliette
Author Affiliations: Discipline of Physiotherapy, School of Medicine, Trinity College (Ms Guinan and Dr Hussey); Department of Surgery, St. James's Hospital (Drs Connolly and Carroll); Department of Clinical Nutrition (Dr Healy); Academic Unit of Clinical and Medical Oncology (Dr Kennedy), St.James's Hospital and Trinity College, Dublin, Ireland.
Cancer Nurs. 2014 Sep-Oct;37(5):355-62. doi: 10.1097/NCC.0b013e3182a40e6d.
Adjuvant breast cancer treatment is associated with a number of adverse physical changes, including weight gain, and therefore may represent a critical period for the development of metabolic disturbance.
The aim of this study was to evaluate changes in the presentation of the metabolic syndrome (MetSyn) and insulin resistance from breast cancer surgery to postcompletion of adjuvant treatment.
Sixty-one participants who had completed metabolic screening, including fasting blood samples and anthropometric measurements, on the morning of breast cancer surgery were recruited. Measures were repeated after completion of adjuvant treatment. Change in the proportion of participants presenting with the MetSyn was evaluated using the related-samples McNemar test, and changes in measures of glucose metabolism (fasting insulin, insulin resistance [homeostatic model assessment index], and glycosylated hemoglobin [HbA1c]) were analyzed using paired t tests. The Kruskal-Wallis test was used to compare differences in changes in metabolic parameters across clinical and lifestyle characteristics.
There was a significant (P < .001) increase in fasting insulin (mean [SE] change, 2.73 [0.57] mU/L), homeostatic model assessment index (0.58 [0.14]), and HbA1c level (4.49 [5.63] mmol/mol) from baseline to follow-up along with an increase in the proportion diagnosed with the MetSyn (P = .03). Those with the MetSyn at diagnosis experienced a greater increase in insulin resistance. Premenopausal women experienced greatest increases in HbA1c level.
Results demonstrate the development of significant metabolic dysfunction, characterized by glucose dysmetabolism and MetSyn, after adjuvant treatment for breast cancer.
Interventions to improve the metabolic profile of breast cancer survivors are warranted.
乳腺癌辅助治疗会带来一系列不良身体变化，包括体重增加，因此可能是代谢紊乱发展的关键时期。
本研究旨在评估从乳腺癌手术到辅助治疗结束后代谢综合征（MetSyn）和胰岛素抵抗表现的变化。
招募了61名在乳腺癌手术当天上午完成代谢筛查（包括空腹血样和人体测量）的参与者。辅助治疗结束后重复进行测量。使用相关样本McNemar检验评估出现MetSyn的参与者比例的变化，使用配对t检验分析葡萄糖代谢指标（空腹胰岛素、胰岛素抵抗[稳态模型评估指数]和糖化血红蛋白[HbA1c]）的变化。使用Kruskal-Wallis检验比较不同临床和生活方式特征的代谢参数变化差异。
从基线到随访，空腹胰岛素（平均[标准误]变化，2.73[0.57]mU/L）、稳态模型评估指数（0.58[0.14]）和HbA1c水平（4.49[5.63]mmol/mol）显著升高（P<.001），同时被诊断为MetSyn的比例增加（P=.03）。诊断时患有MetSyn的患者胰岛素抵抗增加幅度更大。绝经前女性HbA1c水平升高幅度最大。
结果表明乳腺癌辅助治疗后出现了以葡萄糖代谢异常和MetSyn为特征的显著代谢功能障碍。
有必要采取干预措施改善乳腺癌幸存者的代谢状况。
