多模态感知控制运动交互康复对乳腺癌化疗患者癌症相关疲劳水平的影响

黄雅琼; 周芳; 诸伟红; 邹菁; 陈铁霞

doi:10.16766/j.cnki.issn.1674-4152.004411

多模态感知控制运动交互康复对乳腺癌化疗患者癌症相关疲劳水平的影响

doi: 10.16766/j.cnki.issn.1674-4152.004411

黄雅琼^{1, 2},
周芳^3, ,,
诸伟红²,
邹菁²,
陈铁霞²

1.
浙江中医药大学第四临床医学院，浙江杭州 310053
2.
杭州市第一人民医院肿瘤内科，浙江杭州 310006
3.
杭州市第一人民医院乳腺外科

基金项目:

浙江省医药卫生科技计划项目 2022PY079

详细信息

通讯作者:
周芳，E-mail: 642249965@qq.com

中图分类号: R737.9
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- 文章访问数: 18
- HTML全文浏览量: 8
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2025-04-09
- 网络出版日期: 2026-06-02

Effect of multi-mode perception control and motion interactive rehabilitation on cancer related fatigue level of breast cancer patients undergoing chemotherapy

1.
The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China

摘要

摘要: 目的本研究旨在探讨基于多模态感知控制技术构建的运动交互康复系统(MPCI-R)对乳腺癌化疗患者癌症相关疲劳(CRF)的干预效果，并评估其对细胞免疫功能的影响，以期为临床提供更具互动性与个体化的康复方案。方法选取2023年1—12月杭州市第一人民医院乳腺癌术后化疗患者70例，采用随机数表法将患者分为对照组(n=34)和干预组(n=35)。对照组实施常规运动康复与CRF综合管理；干预组在此基础上接受为期8周的MPCI-R(每周≥5次、累计≥150 min，结合可穿戴传感器与虚拟现实反馈的有氧+抗阻训练)。主要结局为Piper疲乏量表中文版(RPFS-C)在基线、干预后4周、干预后8周的评分；次要结局为外周血CD3⁺、CD4⁺、CD8⁺ T细胞及自然杀伤(NK)细胞比例(基线与干预后8周)。结果 2组患者基线RPFS-C比较差异无统计学意义(P>0.05)。干预后4周、8周，与对照组比较，干预组的RPFS-C更低[(4.23±1.52)分vs.(5.59±1.40)分，t=3.873，P < 0.001；(3.43±1.34)分vs.(5.06±1.35)分，t=5.049，P < 0.001]。重复测量方差分析提示组别主效应、时间主效应及组别×时间交互作用均有统计学意义(P < 0.001)。免疫学方面，干预后8周时干预组CD3⁺ T细胞、CD4⁺ T细胞及NK细胞比例高于对照组，且CD8⁺ T细胞比例更低(P＜0.05)。结论在常规管理基础上叠加MPCI-R，可显著降低化疗期乳腺癌患者CRF并优化细胞免疫表型，显示出良好的可行性与推广价值。
- 癌症相关疲劳 /
- 运动 /
- 多模态交互 /
- 乳腺癌化疗 /
- 感知控制
Abstract: Objective This study aims to explore the intervention effect of exercise interactive rehabilitation system (MPCI-R) based on multimodal perceptual control technology on cancer-related fatigue (CRF) in breast cancer patients undergoing chemotherapy, and evaluate its effect on cellular immune function, in order to provide a more interactive and individualized rehabilitation program for clinical practice. Methods Seventy patients undergoing postoperative chemotherapy for breast cancer at Hangzhou First People's Hospital between January and December 2023 were randomly assigned to a control group (n=34) and an intervention group (n=35) using the random number table. The control group received conventional exercise rehabilitation and comprehensive CRF management. The intervention group also received an 8-week MPCI-R (≥5 sessions per week, ≥150 minutes cumulatively, aerobic and resistance training combined with wearable sensors and virtual reality feedback). The primary outcome was the piper fatigue scale-Chinese (RPFS-C) score at baseline, 4 weeks, and 8 weeks. Secondary outcomes were the percentages of CD3⁺, CD4⁺, CD8⁺ T cells, and natural killer (NK) cells in peripheral blood (baseline and 8 weeks). Results Baseline RPFS-C did not differ between groups (P>0.05). At 4 and 8 weeks after intervention, the RPFS-C of the intervention group was lower than that of the control group [(4.23±1.52) vs. (5.59±1.40), t=3.873, P < 0.001; (3.43±1.34) vs. (5.06±1.35), t=5.049, P < 0.001]. Repeated-measures ANOVA indicated significant main effects of group and time and a group×time interaction (P < 0.001). At week 8, the intervention group had higher CD3⁺ T cells, CD4⁺ T cells, and NK cell proportions and lower CD8⁺ T cells proportion than controls (P < 0.05). Conclusion Adding MPCI-R to usual care significantly reduces CRF and favorably modulates immune cell profiles during chemotherapy for breast cancer, supporting its feasibility and potential for broader implementation.
- Cancer related fatigue /
- Sports /
- Multimodal interaction /
- Chemotherapy for breast cancer /
- Perceived control

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表 1 2组乳腺癌化疗患者基线资料比较

Table 1. Comparison of baseline data of two groups of breast cancer patients undergoing chemotherapy

组别	例数	年龄(例)				婚姻状况(例)			居住地(例)			受教育程度(例)
组别	例数	18~45岁	45~60岁	61岁~		有配偶	无配偶		城市	农村		小学及以下	中学(中专)	大学
对照组	34	4	18	12		26	8		27	7		9	19	6
干预组	35	5	17	13		22	13		27	8		6	15	14
统计量		0.165^a				1.510^a			0.052^a			4.257^a
P值		0.921				0.219			1.000			0.119

组别	例数	子女数(例)			医保形式(例)			商业保险(例)			家庭人均月收入(例)			BMI(x±s)
组别	例数	无	有		职工医保	居民医保		有	无		< 3 000元	3000~5 000元	>5 000元	BMI(x±s)
对照组	34	6	28		19	15		17	17		10	15	9	23.03±1.55
干预组	35	6	29		26	9		14	21		10	13	12	23.06±2.03
统计量		0.003^a			2.575^a			0.697^a			0.557^a			0.064^b
P值		0.956			0.109			0.404			0.757			0.949

组别	例数	化疗期照看者(例)			病理类型(例)				分化程度(例)				术后TNM分期(例)
组别	例数	有	无		浸润型	黏液型	小叶癌		低分化	中分化	高分化		T	N
对照组	34	31	3		15	12	7		16	11	7		14	20
干预组	35	29	6		21	6	8		19	7	9		19	16
统计量		1.052^a			3.053^a				1.382^a				1.293^a
P值		0.305			0.217				0.501				0.256

组别	例数	化疗方案(例)				日常生活依赖程度(例)				骨髓抑制程度(例)
组别	例数	CAF	AT	CMF		无	轻度	中度		Ⅰ度	Ⅱ度	Ⅲ度
对照组	34	11	14	9		17	15	2		10	17	7
干预组	35	16	13	6		14	18	3		10	15	10
统计量		1.549^a				0.749^a				0.640^a
P值		0.461				0.688				0.726
注：CAF和AT方案28 d为1个周期，共4个周期；CMF方案28 d为1个周期，共6个周期；中医治疗包括针灸、汤剂、中成药等；^a为χ²值，^b为t值。

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表 2 2组乳腺癌化疗患者干预前后RPFS-C得分比较(x±s，分)

Table 2. Comparison of RPFS-C scores between the two groups before and after intervention (x±s, points)

组别	例数	干预前	干预后4周	干预后8周
对照组	34	5.71±1.22	5.59±1.40^a	5.06±1.35^ab
干预组	35	6.09±1.50	4.23±1.52^a	3.43±1.34^ab
t值		-1.151	3.873	5.049
P值		0.254	< 0.001	< 0.001
注：与同组干预前比较，^aP＜0.05；与同组干预后4周比较，^bP＜0.05。

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表 3 2组乳腺癌化疗患者干预前后T淋巴细胞亚群、NK细胞比例比较(x±s，%)

Table 3. Comparison of T lymphocyte subsets and NK cells before and after intervention in two groups of breast cancer patients with chemotherapy (x±s, %)

组别	例数	CD3⁺ T		CD4⁺ T		CD8⁺ T		NK细胞
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	34	54.59±2.55	65.68±2.67	37.00±1.79	39.09±2.57	35.09±2.40	27.09±2.37	17.94±1.50	21.85±1.44
干预组	35	54.71±3.02	68.06±4.09	36.80±1.49	40.83±2.99	35.03±2.70	25.09±2.68	18.14±2.10	23.40±2.64
统计量		0.187^a	95.352^b	0.504^a	68.245^b	0.097^a	85.486^b	2.528^a	79.634^b
P值		0.852	< 0.001	0.616	< 0.001	0.923	< 0.001	0.458	< 0.001
注：^a为t值，^b为F值。

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参考文献(26)

[1]	SUNG H, FERLAY J, SIEGEL R L, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2]	王少明, 郑荣寿, 韩冰峰, 等. 2022年中国人群恶性肿瘤发病与死亡年龄特征分析[J]. 中国肿瘤, 2024, 33(3): 165-174. WANG S M, ZHENG R S, HAN B F, et al. Age distribution of cancer incidence and mortality in China in 2022[J]. China Cancer, 2024, 33(3): 165-174.
[3]	刘海凤, 戴晓燕, 桑娟, 等. 归因心理调适联合渐进性肌肉放松训练对乳腺癌化疗伴失眠患者身心健康的影响[J]. 中华全科医学, 2024, 22(4): 704-708. doi: 10.16766/j.cnki.issn.1674-4152.003484 LIU H F, DAI X Y, SANG J, et al. Effect of attributed psychological adjustment combined with progressive muscle relaxation training on physical and mental health of patients with breast cancer chemotherapy and insomnia[J]. Chinese Journal of General Practice, 2024, 22(4): 704-708. doi: 10.16766/j.cnki.issn.1674-4152.003484
[4]	GUPTA A, HUSSAIN S M, NAYYAR H K, et al. Perception, magnitude, and implications of cancer-related fatigue in breast cancer survivors: study from a developing country[J]. J Cancer Res Ther, 2021, 17(4): 998-1002. doi: 10.4103/jcrt.JCRT_151_19
[5]	LIU Y C, HUNG T T, KONARA MUDIYANSELAGE S P, et al. Beneficial exercises for cancer-related fatigue among women with breast cancer: a systematic review and network meta-analysis[J]. Cancers (Basel), 2022, 15(1): 151. DOI: 10.3390/cancers15010151.
[6]	PEYRACHON R, RÉBILLARD A. Effects of active video games in patients with cancer: systematic review[J]. JMIR cancer, 2023, 9: e45037. DOI: 10.2196/45037.
[7]	ALVES I, MOREIRA A P, SOUSA T, et al. The effect of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery: a randomized controlled trial[J]. Supportive Care in Cancer, 2024, 32(12): 794. DOI: 10.1007/s00520-024-09005-0.
[8]	曹可鸣, 陈威, 尚荣国, 等. 细胞周期蛋白依赖性激酶4/6抑制剂联合氟维斯群治疗HR阳性/HER2阴性晚期乳腺癌患者的临床综合评价[J]. 临床药物治疗杂志, 2024, 22(S1): 74-80. CAO K M, CHEN W, SHANG R G, et al. Clinical comprehensive evaluation of CDK4/6 inhibitor combined with fulvestrant in HR+/HER2-advanced breast cancer patients[J]. Clinical Medication Journal, 2024, 22(S1): 74-80.
[9]	KIM S, HAN J, LEE M Y, et al. The experience of cancer-related fatigue, exercise and exercise adherence among women breast cancer survivors: insights from focus group interviews[J]. J Clin Nurs, 2020 29(5-6): 758-769. doi: 10.1111/jocn.15114
[10]	邓茹丹, 刘恩慧, 周娟, 等. 三联预康复对晚期三阴性乳腺癌患者生活质量及负性情绪的临床疗效观察[J]. 北京医学, 2025, 47(12): 997-1002. DENG R D, LIU E H, ZHOU J, et al. Clinical observation of effects of trimodal prehabilitation on quality of life and negative emotions in patients with advanced triple-negative breast cancer[J]. Beijing Medical Journal, 2025, 47(12): 997-1002.
[11]	易心武, 薛锦云, 游珍, 等. 沉浸式虚拟现实多模态交互模型研究[J]. 江西师范大学学报(自然科学版), 2024, 48(1): 52-58. YI X W, XUE J Y, YOU Z, et al. The study on immersive virtual reality multimodal interaction model[J]. Journal of Jiangxi Normal University(Natural Science Edition), 2024, 48(1): 52-58.
[12]	武文斌, 胡培, 景红霞, 等. 多模态影像在三阴性乳腺癌诊断中的应用价值[J]. 中华实用诊断与治疗杂志, 2021, 35(12): 1212-1217. WU W B, HU P, JING H X, et al. Value of multimodality imaging to the diagnosis of triple negative breast cancer[J]. Journal of Chinese Practical Diagnosis and Therapy, 2021, 35(12): 1212-1217.
[13]	FEIL K, FRITSCH J, RHODES R E. The intention-behaviour gap in physical activity: a systematic review and meta-analysis of the action control framework[J]. Br J Sports Med, 2023, 57(19): 1265-1271. doi: 10.1136/bjsports-2022-106640
[14]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版)[J]. 中国癌症杂志, 2021, 31(10): 954-1040. Breast Cancer Professional Committee of China Anti-Cancer Association. Guidelines and norms for breast cancer diagnosis and treatment of China Anti-Cancer Association (2021 Edition)[J]. China Oncology, 2021, 31(10): 954-1040.
[15]	中华医学会肿瘤分会支持康复治疗学组. 中国癌症相关性疲乏临床实践诊疗指南(2021年版)[J]. 中国癌症杂志, 2021, 31(9): 852-872. Tumor Support and Rehabilitation Therapy Group, the Oncology Committee of Chinese Medical Association. Clinical practice guidelines for cancer-related fatigue in China(2021 edition)[J]. China Oncology, 2021, 31(9): 852-872.
[16]	张如娜, 段霞. 乳腺癌放化疗患者癌因性疲乏运动干预最佳证据总结[J]. 现代临床护理, 2023, 22(4): 64-70. ZHANG R N, DUAN X. Best evidences of exercise interventions for cancer-related fatigue in patients undergoing radiochemotherapy for breast cancer[J]. Modern Clinical Nursing, 2023, 22(4): 64-70.
[17]	FOX R S, ANCOLI-ISRAEL S, ROESCH S C, et al. Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy[J]. Support Care Cancer, 2020, 28(2): 845-855.
[18]	何佩佩, 陈丽, 孙淼娟, 等. 基于系统教学模式的腹膜透析患者再培训方案的构建及应用[J]. 中华护理杂志, 2024, 59(2): 149-155. HE P P, CHEN L, SUN M J, et al. Construction of a retraining model for peritoneal dialysis patients based on ADDIE model[J]. Chinese Journal of Nursing, 2024, 59(2): 149-155.
[19]	SO W K W, DOGSON J, TAI J W M. Fatigue and quality of lifeamong Chinese patients with hematologic malignancy after bone marrow transplantation[J]. Cancer Nursing, 2003, 26(3): 211-219. doi: 10.1097/00002820-200306000-00006
[20]	胡岚坤. 心理干预配合临床护理路径在乳腺癌整形保乳术围手术期的效果观察: 评《乳腺癌的治疗与护理》[J]. 中国临床研究, 2025, 38(9): 1463. HU L K. Effect of psychological intervention combined with clinical nursing pathway in the perioperative period of plastic breast-conserving surgery for breast cancer: a review of the Treatment and nursing of breast Cancer[J]. Chinese Journal of Clinical Research, 2025, 38(9): 1463.
[21]	CERBAS S, KELEMEN A, LIANG Y, et al. A physical activity mobile game for hematopoietic stem cell transplant patients: App design, development, and evaluation[J]. JMIRx Med, 2021, 2(2): e20461. DOI: 10.2196/20461.
[22]	WANG Y, ZHANG X T, WANG L. Assessing the intention to use sports bracelets among Chinese university students: an extension of technology acceptance model with sports motivation[J]. Front Psychol, 2022, 13(3): 594-607.
[23]	SCOTT J M, LEE J, HERNDON J E, et al. Timing of exercise therapy when initiating adjuvant chemotherapy for breast cancer: a randomized trial[J]. Eur Heart J, 2023, 44(46): 4878-4889. doi: 10.1093/eurheartj/ehad085
[24]	HOLMEN OLOFSSON G, MIKKELSEN M K, RAGLE A M, et al. High intensity aerobic exercise training and immune cell mobilization in patients with lung cancer (HI AIM): a randomized controlled trial[J]. BMC Cancer, 2022, 22(1): 246. DOI: 10.1186/s12885-022-09349-y.
[25]	李欣, 徐咏梅, 富琦, 等. 节拍化疗治疗老年晚期乳腺癌的研究进展[J]. 北京医学, 2024, 46(8): 679-683. LI X, XU Y M, FU Q, et al. Research progress of metronomic chemotherapy in the treatment of elderly patients with advanced breast cancer[J]. Beijing Medical Journal, 2024, 46(8): 679-683.
[26]	LAVÍN-PÉREZ A M, COLLADO-MATEO D, ABBASI S, et al. Effects of exercise on immune cells with tumor-specific activity in breast cancer patients and survivors: a systematic review and meta-analysis[J]. Support Care Cancer, 2023, 31(9): 507. DOI: 10.1007/s00520-023-07968-0.