| 소속 |
Pusan National University Hospital, Department of Rehabilitation Medicine1, East Gimhae Hospital, Department of Rehabilitation Medicine2, Pusan National University Hospital, Biomedical Research Institute3, Pusan National University Hospital, Department of Thoracic and Cardiovascular Surgery4 |
| 저자 |
Ra Yu Yun1*, Myung Jun Shin1, Byeong-Ju Lee1, Sang Hun Kim1, Je-Sang Lee2†, Bo-Hyeon Kim3, Jong-Hwan Park3, Jeong Su Cho4, Hyo Yeong Ahn4 |
Introduction
The purpose of this study was to compare the body composition, cardiopulmonary function, pulmonary function and respiratory muscle strength of lung cancer patients of pre and post lobectomy, and showed following result in relation of removed lung volume with muscle mass, lung function and respiratory muscle strength.
Methods
The present study was approved by the Institutional Review Board (IRB) at B Hospital. Recruitment notices were posted at the thoracic surgery and rehabilitation medicine clinic at B Hospital to recruit patients scheduled to undergo video-thoracoscopic lobectomy for lung cancer. Before lobectomy, the patients underwent computed tomography (CT), cardiopulmonary exercise testing (CPET), pulmonary function test, Inbody dual energy X-ray absorptiometry (DEXA), whole body DEXA, and grip strength measurements. These tests were repeated four weeks after surgery. One week after surgery, all tests except CT, CPET, and whole body DEXA were performed. All evaluations were performed by a single skilled physician.
Thirteen patients with lung cancer were enrolled in this study. Their mean age was 65±6.84 years, with 9 men and 4 women.
Result
The maximum oxygen uptake per body weight was significantly decreased from 26.34±6.98 ml/kg/min to 23.13±4.66 ml/kg/min after 4 weeks(p<.01). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) showed significant differences between pre-operation, 1 week and 4 weeks of operation. Maximal inspiratory pressure (MIP) was significantly different between the periods(p<.05). Peak expiratory flow (PEF) was also significantly different between the periods(p<.001).
The correlation between muscle mass and MIP, muscle mass and PEF is shown in and . Muscle mass and MIP showed significant correlation between the spearman correlation(r=.521, p=.013) and partial correlation coefficient(r=.517, p=.023). Muscle mass and PEF showed significant correlation between the spearman correlation(r=.500, p=.018) and partial correlation coefficient(r=.473, p=.018).
The correlation between muscle mass, respiratory muscle strength, pulmonary function according to pre and post-operative lung volume is shown in . Spearman correlations were used to calculate coefficients of correlation among delta lung volume and skeletal muscle mass, respiratory muscle, pulmonary function. Statistical analysis was conducted by using partial correlation, adjusted for age, BMI, gender. Differences in lung volume before and after surgery showed significant correlation by appendicular lean mass (ALM) (r=.690, p=.001), MIP(r=.403, p=.043), PEF(r=.413, p=.045), FVC(r=.705, p=.001), FEV1(r=.484, p=.022).
Conclusion
In conclusion, the increase in muscle mass due to lung volume difference in lung cancer patients will have positive effect on survival rate, respiratory muscle strength and lung function and therefore have positive result to viability and quality of life of the patients.
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Figure 1. The relationship between MIP and total lean mass in patients with lung cancer.
Figure 2. The relationship between PEF and total lean mass in patients with lung cancer
Table 1. The correlation between delta lung volume and skeletal muscle mass, respiratory muscle strength, pulmonary function in patients with lung cancer
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