【作者】 王玉侠；

【导师】 王人卫；

【作者基本信息】 上海体育学院 ， 运动人体科学， 2011， 博士

【摘要】 研究目的:探讨自控锻炼对术后康复期恶性肿瘤患者红细胞免疫及其抗氧化功能、淋巴细胞亚群及血清相关因子的影响,为恶性肿瘤患者在常规治疗后的康复期,通过非药物疗法进行康复锻炼提供理论依据和科学指导,为自控锻炼对癌症患者机体机能影响的研究提供资料。研究对象与方法:1受试对象:以上海市癌症康复学校新入校学员新入学员40名为研究对象,其中男性17名,平均年龄为59.82±7.97(42岁～71岁);女性23名,平均年龄为55.78±5.42(48岁～66岁),平均癌龄为1.50±0.77年。实验至12周时,由于病情等原因,有3例患者缺失,2例患者病逝,共有35名受试者参加测试。病种分别为乳腺癌17例,消化系统癌14例,其他类型恶性肿瘤患者9例(包括卵巢癌2例、肺癌3例、甲状腺癌2例、肉瘤1例、前列腺癌1例、),所有受试对象均通过癌症病史及一般性健康检查,自愿参加本研究,签署知情同意书;均经临床诊断确诊,并经手术~+化疗常规治疗后,由医生综合病史资料、运动适宜性和体格检查的总体情况签署医学批准书,接受有指导的自控锻炼。2锻炼方案:受试者结束手术结合放化疗常规治疗后,在专门人员指导下,首先进行3周的自控锻炼学习,然后进行24周的自控锻炼,平均每天锻炼时间2小时,平均锻炼频率为每周5天。3跟踪随访:通过预约定点公园有计划对受试者进行锻炼指导和医务监督。同时不定期电话、家访、E-mail等通讯方式进行追踪随访。4指标测试:于实验第0周、12周、24周分别采用流式细胞仪方法测定患者外周血红细胞CD35、CD58平均荧光强度、淋巴细胞CD3~+、NK细胞(CD3-/CD16~+CD56~+)、NKT细胞(CD3~+/CD16~+CD56~+)分子表达、腺嘌呤氧化酶法测定红细胞抗氧化酶SOD活性、DTNB法测红细胞GSH-Px活性、硫代巴比妥酸法测血浆MDA含量、酶联免疫法测血清β-内啡肽及IL-2含量等指标,并且对实验期间相关指标进行相关分析。研究结果:1自控锻炼对恶性肿瘤患者红细胞CD35、CD58分子表达的影响与实验第0周比较,实验第12周、24周不同性别患者红细胞计数、血红蛋白含量及红细胞压积均无明显变化(P>0.05)。与实验第0周比较,患者红细胞CD35荧光强度第12周明显升高(P<0.01);第24周较第12周表现为明显下降(P<0.01),但仍显著高于实验第0周(P<0.01)。第12周红细胞CD58荧光强度较第0周显著下降(P<0.01);第24周明显高于实验第12周(P<0.01),回升到实验第0周水平(P>0.05)。2自控锻炼对恶性肿瘤患者红细胞抗氧化能力的影响自控锻炼12周后,术后康复期恶性肿瘤患者E-SOD活性显著高于实验第0周(P<0.01),第24周较第12周明显下降(P<0.01),但仍略高于实验第0周,虽然差异无统计学意义(P>0.05)。12周自控锻炼干预后,患者E-GSH-Px活性较第0周有升高趋势,但差异无统计学意义(P>0.05);第24周,E-GSH-Px活性继续保持升高的趋势,然而与实验第0周、第12周比较,均无统计学意义(P>0.05)。与实验第0周比较,实验第12、24周,肿瘤患者血浆MDA水平均明显降低(P<0.01,P<0.01),实验第24周与第12周无明显差异(P>0.05)。3自控锻炼对恶性肿瘤患者淋巴细胞亚群的影响实验第12周CD3~+淋巴细胞较第0周有升高趋势,但差异无统计学意义(P>0.05),然而实验进行至第24周时,CD3~+淋巴细胞较实验第12周持续升高(P>0.05),明显高于实验第0周(P<0.01);与实验第0周比较,实验第12周CD3-CD16~+CD56~+NK细胞百分比明显升高(P<0.05),实验第24周,CD3-CD16~+CD56~+NK细胞百分比不仅明显高于实验第0周(P<0.01),还显著高于实验第12周(P<0.05)。实验第12周患者外周血CD3~+CD16~+CD56~+NKT表达明显高于第0周(P<0.05),第24周较第12周呈下降趋势(P>0.05),但仍略高于第0周(P>0.05)。4自控锻炼对恶性肿瘤患者血清β-内啡肽及IL-2的影响恶性肿瘤患者血清β-EP含量实验第12周较第0周有升高趋势,但无统计学差异(P>0.05);实验第24周较实验第12周显著降低(P<0.01),并且较实验第0周偏低,但无统计学意义(P>0.05)。血清IL-2水平随着自控锻炼的持续进行呈升高趋势,然而与实验第0周比较,无论是实验第12周,还是实验至24周,差异均无统计学意义(P>0.05)。研究结论:1 24周自控锻炼能够提高术后康复期恶性肿瘤患者红细胞CD35相对数量,为红细胞发挥其免疫粘附功能提供必要的物质基础;然而对红细胞CD58表达无明显影响。2 24周自控锻炼能够改善术后康复期恶性肿瘤患者红细胞抗氧化酶活性,有效提高红细胞抗氧化功能;降低恶性肿瘤患者血浆脂质过氧化物水平,减少氧化应激对机体造成的过氧化损伤,对于维持恶性肿瘤患者机体内环境稳态具有积极意义。3 24周自控锻炼能够明显提高术后康复期恶性肿瘤患者外周血CD3~+、NK、NKT细胞相对含量,有利于促进机体对肿瘤的免疫调控及免疫杀伤作用。4 24周自控锻炼对于术后康复期恶性肿瘤患者血清β-EP和IL-2水平无明显影响。更多还原

【Abstract】 Objective:The aim of this study was to make it clear the effect of Self-Control Exercise on erythrocyte immunity, antioxidant function of erythrocyte, subsets of lymphocyte and relative factors in serum on malignant tumor patients during their rehabilitation stage after surgery, which could offer a guideline for cancer patients to improve health after conventional therapy, and try to enrich refernce material about study on physical activity and cancer rehabilitation.Setting and participants:1 Participants: 40 new malignant tumor patients were recruited from Shanghai Cancer Club, of which there were 17 men (aged from 42 to 71 years old ) and 23 women(aged from 48 to 66 years old). The mean cancer age of them all was 1.50±0.77years, and the type of tumor included breast cancer (17 patients), digestive cancer (14 patients) and others including ovary cancer, lung cancer, thyroid gland cancer, sarcoma,and prostate cancer). All the patients were diagnosed pathologically and were treated with surgery and chemotherapy. They were all willing to participate in this study, After signing their names on informed consent form, they performed 24-week moderate intensive training program of Self-Control Exercise.2 Protocal: After conventional treatment of surgery and chemotherapy, all the patients learned to practice Self-Control Exercise for 3 weeks, then they left the club and began to do exercise regularly for two stages, and the fist stage lasted from 0 or 12th week while the second stage was from the 13rd to 24th week. The patients finished Self-Control Exercise about 5 days per week and each day the total exercise time was about 2 hours.3 Following-up: Going to the park to meet them and providing help on exercise and medical supervision to them.4 Main outcomes: Erythrocyte CD35, erythrocyte CD58, lymphocyte CD3~+, CD3-/CD16~+CD56~+NK and CD3~+/CD16~+CD56~+ NKT were measured by the method of flow cytometry; the activity of erythrocyte SOD , E-GSH-Px were tested by xanthine oxidase and DTNB respectively, plasma MDA was measured by thiobarbituric acid and serumβ-EP and IL-2 was measured by ELISA.Results:1 Effects of Self-Control Exercise on erythrocyte CD35 and CD58 in malignant tumor patients during rehabilitation stage after surgery.. The count of red blood cell, level of hemoglobin and hematocrit did not change significantly after 12 or 24 weeks’exercerse in malignant tumor patients after surgery during rehabilitation.(P>0.05).Erythrocyte CD35 increased significantly after 12 weeks’intervention (P<0.01), it attenuated in the 24th week compared with 12th week(P<0.01), however, it still remained a higher level than that before experiment(P<0.01). Erythrocyte CD58 decreased significantly after 12-week’s intervention (P<0.01), while it increased in the 24th week compared with that of the 12th week (P<0.01) and there was no significant difference between 0 and 12 week.2 Effects of Self-Control Exercise on erythrocyte antioxidant in malignant tumor patients during rehabilitation stage after surgery.The activity of erythrocyte SOD increased significantly after the patients took 12-week’s exercise (P<0.01), though it decreased in the 24th week.(P<0.01), it still remained a higher trend compared with that before experiment(P>0.05).The activity of erythrocyte GSH-Px kept an increasing trend during the 12- and 24-week’s Self-Control Exercise intervention, however, there was no significant difference between the 12th and 0th week, 24th and 0th week..Plasma MDA of patients both at the 12th week and 24th week after exercise intervention was much lower than 0 week respectively(P<0.01, P<0.01), though there was no significant difference between 12th and 24th week.3 Effects of Self-Control Exercise on lymphocyte subsets in malignant tumor patients during rehabilitation stage after surgery..Peripheral blood CD3~+ did not change significantly after 12-week’s exercise intervention (P>0.05), while it increased significantly in the 24th week (P<0.01). CD3-CD16~+CD56~+NK increased significantly in the 12th week compared with 0 week (P<0.05), and in the 24’s week, it was not only higher than 0 week (P<0.01), but higher than the 12th week (P<0.05).NKT increased significantly in the 12th week after exercise intervention (P<0.05), however it had a decreasing trend in the 24th week (P>0.05), but it still showed a little higher than the 0 week (P>0.05).4 Effects of Self-Control Exercise on serumβ-EP and IL-2 in malignant tumor patients during rehabilitation stage after surgery..Serumβ-EP and IL-2 both had an increasing trend after 12-week’s exercise intervention, though it had no significance statistically(P>0.05, P>0.05). And serumβ-EP in the 24th week decreased significantly compared with the 12th week, (P<0.01), however it has no difference compared with the 0 week (P>0.05); serum IL-2 still kept an increasing trend in the 24th week, though there was no significant difference between 0 week and 24 week (P>0.05).Conclusions:1 24-week’s Self-Control Exercise could improve erythrocyte CD35 in malignant tumor patients after surgery, which might help erythrocyte to execute its immune function, however, erythrocyte CD58 had no significant change after 24-week’s Self-Control Exercise intervention.2 24-week’s Self-Control Exercise could increase activity of erythrocyte antioxidant in malignant tumor patients after surgery, and decrease the level of plasma MDA, so that it could help the body to avoid damage from oxidative stress and keep an internal environment homeostasis.3 24-week’s Self-Control Exercise could increase the level of peripheral blood CD3~+, NK and NKT in malignant tumor patients after surgery, which indicates an improved immune supervision and immune cytotoxicity.4 There was no significant effect of 24-week’s Self-Control Exercise on serumβ-EP and IL-2 in malignant tumor patients after surgery during rehabilitation..更多还原