圣犹大儿童研究医院终身队列研究中儿童癌症成年幸存者的自主神经功能障碍

Autonomic Dysfunction Among Adult Survivors of Childhood Cancer in the St. Jude Lifetime Cohort Study.

作者信息

Groarke John D, Ness Kirsten K, Dhaduk Rikeenkumar, Plana Juan C, Durand Jean Bernard, Luepker Russell V, Joshi Vijaya M, Ehrhardt Matthew, Mulrooney Daniel A, Dixon Stephanie B, Nohria Anju, Green Daniel M, Howell Rebecca M, Srivastava Deo Kumar, Jefferies John L, Robison Leslie L, Hudson Melissa M, Armstrong Gregory T

机构信息

Department of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA (affiliation for J.D.G. at time research was conducted).

Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

出版信息

JACC CardioOncol. 2024 Oct 8;6(5):775-787. doi: 10.1016/j.jaccao.2024.08.005. eCollection 2024 Oct.

DOI:10.1016/j.jaccao.2024.08.005

PMID:39479326

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11520214/

Abstract

BACKGROUND

The burden and functional significance of autonomic dysfunction among survivors of childhood cancer is unknown.

OBJECTIVES

We evaluated the prevalence, risk factors, and functional relevance of autonomic dysfunction in survivors.

METHODS

We conducted a cross-sectional prospective evaluation of 1,041 adult survivors of childhood cancer treated with anthracyclines (31.1%), chest-directed radiation (13.5%), both (19.5%), or neither (35.9%), and 286 community control subjects enrolled in the SJLIFE (St Jude Lifetime Cohort Study). Four measures of autonomic dysfunction were evaluated: elevated resting heart rate, decreased heart rate reserve, decreased systolic blood pressure response to exercise, and delayed heart rate recovery. Logistic regression tested associations with impaired cardiorespiratory fitness (peak Vo < 80% predicted).

RESULTS

Survivors (50.7% female) were 9.0 ± 5.8 years at cancer diagnosis and 35.5 ± 8.9 years at evaluation. Prevalence (survivors vs control subjects) of elevated resting heart rate (17.9% vs 7.0%), decreased heart rate reserve (21.7% vs 9.1%), decreased systolic blood pressure response to exercise (25.3% vs 12.6%), and delayed heart rate recovery (24.3% vs 10.6%) was more than 2-fold higher among survivors ( < 0.001 for all). Carboplatin (adjusted OR: 2.50; 95% CI: 1.42-4.40; = 0.001), chest-directed radiation therapy (adjusted OR: 2.06; 95% CI: 1.52-2.75; < 0.001), and cranial radiation (adjusted OR: 1.49; 95% CI: 1.08-2.05; = 0.015) were associated with an increased likelihood of having ≥2 measures of autonomic dysfunction. Survivors with ≥2 measures of autonomic dysfunction were at increased risk for impaired cardiorespiratory fitness (adjusted OR: 2.71; 95% CI: 1.82-4.02; < 0.001).

CONCLUSIONS

Survivors of childhood cancer manifest a higher prevalence of autonomic dysfunction associated with impaired cardiorespiratory fitness.

摘要

背景

儿童癌症幸存者自主神经功能障碍的负担和功能意义尚不清楚。

目的

我们评估了幸存者自主神经功能障碍的患病率、危险因素及功能相关性。

方法

我们对1041名接受过蒽环类药物治疗（31.1%）、胸部定向放疗（13.5%）、两者皆有（19.5%）或两者皆无（35.9%）的儿童癌症成年幸存者，以及286名参与圣犹大终身队列研究（SJLIFE）的社区对照者进行了横断面前瞻性评估。评估了自主神经功能障碍的四项指标：静息心率升高、心率储备降低、运动时收缩压反应降低和心率恢复延迟。采用逻辑回归分析与心肺适能受损（峰值摄氧量<预测值的80%）的相关性。

结果

幸存者（50.7%为女性）癌症诊断时的年龄为9.0±5.8岁，评估时为35.5±8.9岁。静息心率升高（17.9%对7.0%）、心率储备降低（21.7%对9.1%）、运动时收缩压反应降低（25.3%对12.6%）和心率恢复延迟（24.3%对10.6%）的患病率（幸存者与对照者相比）在幸存者中高出2倍多（所有P<0.001）。卡铂（校正比值比：2.50；95%置信区间：1.42 - 4.40；P = 0.001）、胸部定向放射治疗（校正比值比：2.06；95%置信区间：1.52 - 2.75；P<0.001）和颅脑放疗（校正比值比：1.49；95%置信区间：1.08 - 2.05；P = 0.015）与出现≥2项自主神经功能障碍指标的可能性增加相关。有≥2项自主神经功能障碍指标的幸存者心肺适能受损风险增加（校正比值比：2.71；95%置信区间：1.82 - 4.02；P<0.001）。