心脏康复对弥漫性大B细胞淋巴瘤患者心肺功能及生活质量的影响

Effects of Cardiac Rehabilitation on Cardiopulmonary Function and Quality of Life in Patients with Diffuse Large B-Cell Lymphoma

摘要: 目的：探讨12周心脏康复对接受心脏毒性药物化疗的弥漫性大B细胞淋巴瘤(Diffuse Large B-Cell Lymphoma, DLBCL)患者身体成分、静息心率、心肺功能及生活质量的影响。方法：将30例接受含蒽环类药物化疗的DLBCL患者随机分为心脏康复组(CR组，n = 15)和对照组(CG组，n = 15)。CR组按照制定心脏康复方案进行干预，包括为期12周、每周3次、每次60分钟的有氧运动(强度为60%~85%心率储备)及健康教育、营养指导、心理干预等，对照组患者进行日常活动及接受常规护理指导。干预前后分别测量两组患者的身体成分、静息心率、最大摄氧量(VO_2peak)，并采用EORTC QLQ-C30量表评估生活质量。结果：12周干预后，CR组骨骼肌量显著增加(P < 0.001)，腰臀比显著降低(P < 0.001)；静息心率显著减慢(P < 0.001)，最大摄氧量(VO_2peak)由(1192.27 ± 99.93) ml/min提升至(1403.33 ± 76.45) ml/min (P < 0.001)；生活质量(EORTC QLQ-C30)评分显示，CR与CG组生活质量均有所提升，CR组生活质量总分由(63.73 ± 3.11)分提升至(85.60 ± 4.39)分(P < 0.001)，且改善幅度显著大于CG组。结论：12周心脏康复可有效改善接受心脏毒性化疗的DLBCL患者的骨骼肌量、心肺耐力及生活质量，是减轻化疗相关心脏毒性的可行干预措施。

Abstract: Objective: To explore the effects of 12-week cardiac rehabilitation on body composition, resting heart rate, cardiopulmonary function and quality of life in patients with diffuse large B-cell lymphoma (DLBCL) receiving chemotherapy with cardiotoxic agents. Methods: A total of 30 DLBCL patients receiving anthracycline-based chemotherapy were randomly assigned to cardiac rehabilitation group (CR group, n = 15) and control group (CG group, n = 15). Patients in the CR group received a 12-week cardiac rehabilitation intervention, including aerobic exercise 60 minutes per session, 3 times per week at an intensity of 60%~85% heart rate reserve, as well as health education, nutritional guidance and psychological intervention. Patients in the control group maintained routine daily activities and received conventional nursing guidance. Body composition, resting heart rate and peak oxygen uptake (VO_2peak) were measured before and after intervention. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) was used to evaluate patients’ quality of life. Results: After 12-week intervention, skeletal muscle mass was significantly increased (P < 0.001), whereas waist-to-hip ratio was markedly decreased (P < 0.001) in the CR group; resting heart rate was significantly reduced (P < 0.001). VO_2peak increased from (1192.27 ± 99.93) ml/min to (1403.33 ± 76.45) ml/min (P < 0.001). Quality-of-life scores assessed by EORTC QLQ-C30 showed improvements in both groups. The total quality-of-life score in CR group rose from (63.73 ± 3.11) to (85.60 ± 4.39) (P < 0.001), with more prominent improvement compared with the CG group. Conclusion: Twelve-week cardiac rehabilitation can effectively improve skeletal muscle mass, cardiopulmonary endurance and quality of life among DLBCL patients undergoing cardiotoxic chemotherapy. It serves as a feasible intervention to alleviate chemotherapy-related cardiotoxicity.