乳腺癌患者接受蒽环类药物或抗HER2治疗期间的结构化运动与心脏结局：随机试验的系统评价和荟萃分析。
完整摘要 · 中文译文
目的：评估与非经常性护理相比，结构化运动是否能保留接受蒽环类药物和/或抗HER2治疗的乳腺癌女性的左心室射血分数（LVEF）、整体纵向应变（GLS）和心脏生物标志物。 方法：我们对随机对照试验进行了系统评价和荟萃分析。采用修订版Cochrane随机试验偏倚风险工具（RoB 2）评估偏倚风险，采用推荐意见分级评估、制定与评价（GRADE）方法评估证据确定性。当临床和方法学上可比时，使用随机效应模型将效应合并为变化的净差异（ΔEG - ΔCG）。主要合成仅限于基线至蒽环类药物治疗结束的时间窗口（约4个月）。 结果：共纳入7项试验（9篇报告；n = 513）。大多数试验存在一定担忧或高偏倚风险。仅两项试验可行定量合成。LVEF（MD 0.07，95% CI -1.38至1.52；I² = 28.2%）或GLS（MD -0.10，95% CI -0.79至0.58；I² = 0%）未观察到组间差异。置信区间较宽，与获益、无效果或危害均兼容。生物标志物数据异质性过大，无法进行荟萃分析。未报告比较性临床心血管事件和生存结局，也未对射血分数保留的心力衰竭（HFpEF）进行正式评估。 结论：当前随机证据稀少、异质性高且确定性低。现有数据未能确认运动具有一致的心脏保护作用。 关于左心室射血分数（LVEF）或整体纵向应变（GLS）的锻炼研究，不允许得出关于临床心血管事件、生存或射血分数保留型心力衰竭（HFpEF）的结论。
完整摘要 · 英文原文
PURPOSE: To evaluate whether structured exercise, compared with usual care, preserves left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and cardiac biomarkers in women with breast cancer receiving anthracyclines and/or anti-HER2 therapy. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials. Risk of bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2), and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. When clinically and methodologically comparable, effects were pooled as net differences in change (ΔEG - ΔCG) using random-effects models. The primary synthesis was restricted to the baseline-to-end-of-anthracycline-treatment window (~ 4 months). RESULTS: Seven trials (9 reports; n = 513) were included. Most trials had some concerns or high risk of bias. Quantitative synthesis was feasible in only two trials. No between-group differences were observed for LVEF (MD 0.07, 95% CI - 1.38 to 1.52; I2 = 28.2%) or GLS (MD - 0.10, 95% CI - 0.79 to 0.58; I2 = 0%). Confidence intervals were wide and compatible with benefit, no effect, or harm. Biomarker data were too heterogeneous for meta-analysis. Comparative clinical cardiovascular-event and survival outcomes and formal assessments of heart failure with preserved ejection fraction (HFpEF) were not reported. CONCLUSION: Current randomized evidence is sparse, heterogeneous, and of low certainty. Available data do not confirm a consistent cardioprotective effect of exercise on LVEF or GLS and do not permit conclusions about clinical cardiovascular events, survival, or HFpEF.