暴露于胸部放射治疗后的传统霍奇金淋巴瘤（HL）幸存者存在着与心肺损害密切相关的严重并发症，其可能也会对神经认知结果产生影响。我们纳入了204名幸存者（女性52.5%，平均[标准偏差]年龄36.6[8.01]岁），这些幸存者接受了胸部放射治疗，并与其年龄、性别和种族/民族匹配的社区对照组（N=205，女性51.7%，年龄36.7[9.17]岁）一同完成了标准化神经认知测试、心脏超声检查、肺功能测试以及血管研究，所有的测试在同一次访视中进行。治疗方案信息从医务记录中提取。使用多变量线性回归模型评估与年龄调整的神经认知表现相关的心脏指标（如左心室射血分数[LVEF]、全局纵向应变[GLS]）、血管指标（如大血管弹性[LAE]和小动脉弹性[SAE]）、肺功能指标（如肺一氧化碳弥散容积[DLCO]、强迫呼气容积[FEV1]）以及慢性健康状况。与对照组相比，幸存者在视动能力（0.11对0.41）、视觉处理速度（0.25对0.64）、短期回忆能力（-0.24对0.12）和心理灵活性（-0.04对0.28）方面表现较差（P<0.05）。幸存者在肺功能（FEV1降低至82.69%对96.23%；DLCOcorr降低至83.31%对98.03%）、心脏功能（LVEF降低至56%对60%；GLS降低至-18.30%对-20.37%）和血管功能（SAE降低至6.94对8.25mL/mm Hg）方面均低于对照组（所有P值<0.001）。FEV1与视动能力（β[95%置信区间] 0.11[0.003-0.02]，P=0.008）、视觉处理速度（0.01[0.004-0.20]，P=0.05）以及心理灵活性（0.01[-0.001-0.03]，P=0.05）相关。GLS与短期回忆能力相关（0.06[0.005-0.11]，P=0.03）。SAE与心理灵活性相关（0.09[0.02-0.16]，P=0.007）。神经认知结果还与中重度神经慢性病变相关（P<0.05）。研究发现提示亚临床心肺和血管研究结果与神经疾病、神经认知障碍之间存在联系。预防健康并发症可能有益于神经认知结果。版权所有 © 2023年美国血液学会。

Thoracic radiation is associated with significant cardiopulmonary morbidities in long-term Hodgkin lymphoma (HL) survivors and may impact neurocognitive outcomes. Survivors (N=204, 52.5% female, mean[SD] age 36.6[8.01] years), treated with thoracic radiation, and age-, sex- and race/ethnicity-matched community controls (N=205, 51.7% female, age 36.7[9.17] years) completed standardized neurocognitive testing, echocardiography, pulmonary function tests, and vascular studies during the same visit. Treatments were abstracted from medical records. Cardiac (i.e., left ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), vascular (i.e., large [LAE] and small artery elasticity [SAE]), pulmonary (i.e., diffusing capacity of the lungs for carbon monoxide [DLCO], forced expiratory volume [FEV1]), and chronic health conditions were evaluated for associations with age-adjusted neurocognitive performance using multivariable linear regression. Compared to controls, survivors had lower performance (P's<0.05) in visuomotor (0.11 v 0.41), visual processing speed (0.25 v 0.64), short-term recall (-0.24 v 0.12), and flexibility (-0.04 v 0.28). Survivors had lower pulmonary (FEV1 82.69% v 96.23%; DLCOcorr 83.31% v 98.03%), cardiac (LVEF 56% v 60%; GLS -18.30% v -20.37%), and vascular function (SAE 6.94 v 8.25 mL/mm Hg) than controls (all p's<0.001). FEV1 was associated with visuomotor (β[95% CI] 0.11[0.003-0.02], p=0.008) and visual processing speed (0.01[0.004-0.20], p=0.05), and flexibility (0.01[-0.001-0.03], p= 0.05). GLS was associated with short-term recall (0.06[0.005-0.11], p=0.03). SAE was associated with flexibility (0.09[0.02-0.16], p=0.007). Neurocognitive outcomes were also associated with moderate to severe neurologic chronic conditions (p's<0.05). Findings suggest a link between subclinical cardiopulmonary and vascular findings, neurologic morbidity, and neurocognitive impairments. Prevention of health morbidity may benefit neurocognitive outcomes.Copyright © 2023 American Society of Hematology.