知识与财富的链接
目的探讨24h动态心电图联合心肌肌钙蛋白Ⅰ(cTnI)评价胸部肿瘤放疗治疗诱发放射性心脏损伤(RIHD)的应用价值。方法选取临沂市第三人民医院2015-2018年间接受放疗±化疗的胸部肿瘤患者128例,分别于放疗前、放疗30Gy、放疗50Gy、放疗结束、放疗结束3个月行常规心电图检查、24h动态心电图检查、cTnI、心脏彩超。比较24h动态心电图、常规心电图、cTnI、心脏彩超、24h动态心电图联合cTnI对RIHD检出率。比较血糖高低、合并高血压病及冠心病、联合化疗、照射剂量及心脏受照面积大小等因素与RIHD发生的关系。结果放疗前后24h动态心电图与常规心电图检测异常结果相近(P均>0.05),而在心律失常、房室传导阻滞、束支传导阻滞、ST-T改变方面均高于常规心电图(P均<0.05)。24h动态心电图联合cTnI与单纯24h动态心电图、常规心电图、cTnI、心脏彩超比较检出率均高于任一方式(P均<0.05)。放疗后RIHD率高于放疗前(P均<0.05);放化疗者心脏损伤率明显高于单药顺铂化疗、单纯放疗组,以表柔比星+环磷酰胺方案为甚(发生率45%,P均<0.05)。单纯放疗与放疗+顺铂化疗的相近(P均>0.05)。放疗后比放疗前RIHD分级增加31.2%(P均<0.05)。合并糖尿病、高血压病、冠心病,放疗合并化疗,心脏Dmean、V40 Gy是1-4级RIHD发生的影响因素(P均<0.05)。结论24h动态心电图联合cTnI评价胸部肿瘤放疗诱发RIHD检出率高,并且操作简单、费用低廉,值得临床推广应用。
Objective To investigate the value of 24-hour dynamic electrocardiogram combined with cardiac troponin I (cTnI) in evaluating the radiation-induced heart disease (RIHD) in chest tumor radiotherapy. Methods From 2015 to 2018, 128 patients with chest tumor who received radiation therapy with/without chemotherapy in the Third People′s Hospital of Linyi were selected to undergo routine ECG examination, 24-hour dynamic ECG examination, cTnI and cardiac color Doppler ultrasound before radiotherapy, 30Gy radiotherapy, 50Gy radiotherapy, after radiotherapy and 3 months after radiotherapy, respectively. The detection rates of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI, cardiac color Doppler ultrasound and 24-hour dynamic electrocardiogram combined with cTnI for RIHD were statistically compared. The correlation between glucose level, hypertension and coronary heart disease, combined with chemotherapy, radiation dose and the irradiated area of the heart and the incidence of RIHD was analyzed. Results The detection rates for RIHD did not significantly differ between 24-hour dynamic electrocardiogram and routine electrocardiogram (P>0.05), whereas the detection rates for arrhythmia, atrioventricular block, bundle branch block and ST-T changes of 24-hour dynamic electrocardiogram were significantly higher than those of routine electrocardiogram (all P<0.05). The detection rate of 24-hour dynamic electrocardiogram combined with cTnI was significantly higher compared with that of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI or cardiac color Doppler ultrasound alone (all P<0.05). There was a significant difference in RIHD before and after radiotherapy (P<0.05). The incidence rate of RIHD in the radiation therapy combined with chemotherapy group was significantly higher than those in the cisplatin chemotherapy and radiotherapy alone groups, especially in the epirubicin+ cyclophosphamide group (45%, all P<0.05). The incidence rate of RIHD was similar between radiotherapy alone and radiotherapy combined with cisplatin chemotherapy (both P>0.05). After radiation therapy, the grade of RIHD was elevated in 40 cases (31.2%). Diabetes mellitus, hypertension, coronary heart disease, radiotherapy combined with chemotherapy, cardiac Dmean and cardiac V40Gy were the independent factors for the occurrence of grade 1-4 RIHD (all P<0.05). Conclusion The 24-hour dynamic electrocardiogram combined with cTnI is of great value in the detection of RIHD induced by radiotherapy for chest tumors with high detection rate, simple operation and low cost, which is worthy of application in clinical practice.
