253例乳腺癌患者蒽环治疗相关急性心脏毒性的临床研究

发布时间：2018-02-24 23:25

本文关键词： 蒽环 QTc 心电图异常急性心脏毒性危险因素　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析253例乳腺癌患者使用蒽环类药物治疗后出现心电图异常的临床特点,探讨使用蒽环类药物治疗的乳腺癌患者发生急性心脏毒性的危险因素。材料与方法:收集253例组织学或细胞学确诊为乳腺癌、使用过3—8周期蒽环药物化疗、化疗前心电图无异常的患者,回顾性分析蒽环药物化疗前后的心电图变化,将心电图发生异常改变作为蒽环治疗急性心脏毒性的诊断指标。总结各类心电图异常变化在乳腺癌蒽环化疗患者中的发生率及校正后QT间期(QTc)随化疗周期数的变化特点。对比患者的年龄、身体质量指数(BMI)、肿瘤TNM分期、既往是否存在高血压及糖尿病史、是否联合放疗、蒽环类药物的种类及累积剂量等因素在心电图异常组和无心电图异常组患者间的差别是否有统计学意义,以及蒽环类药物出现心电图异常与上述各因素之间是否存在相关性。并通过回归分析总结乳腺癌患者应用蒽环类药物治疗后出现急性心脏毒性的危险因素。结果:253例患者中出现心电图异常变化者共92例,发生率为36.36%,其中电生理和节律异常改变78例,发生率30.83%,发生率由高到低依次为:T波改变、ST改变、窦性心动过速、窦性心动过缓、房性期前收缩、室性期前收缩、异常Q波、房室传导阻滞、右束支传导阻滞、交界性早搏;QTc延长31例,发生率12.25%。QTc1—4周期内延长幅度较大且有统计学意义(p均0.05),5—8周期有所延长但差异无统计学意义(p均0.05)。蒽环类药物治疗后发生心电图异常在蒽环累积剂量及年龄之间的差别有统计学意义(p均0.05),进一步分析得出患者年龄为急性心脏毒性的独立危险因素(p0.05)。而其他因素,如体重指数BMI、肿瘤TNM分期、高血压病史、糖尿病病史、联合同步放疗、蒽环药物种类与心电图异常改变的关联无统计学意义(p均0.05)。结论:蒽环类药物治疗期间急性心脏毒性事件发生率较高,主要表现为电生理和节律异常改变、QTc延长。QTc随蒽环化疗周期的增加呈增长趋势。患者年龄及蒽环药物累积剂量与急性心脏毒性具有相关性,其中患者年龄是蒽环药物急性心脏毒性的独立危险因素。因此在治疗过程中应加强对老年患者的心脏监护,并控制蒽环药物的累积剂量在安全范围内。
[Abstract]:Objective: to analyze the clinical features of abnormal electrocardiogram (ECG) in 253 patients with breast cancer treated with anthracycline. To investigate the risk factors of acute cardiac toxicity in breast cancer patients treated with anthracycline drugs. Materials and methods: 253 cases of breast cancer diagnosed by histology or cytology were collected and treated with anthracycline chemotherapy for 3-8 cycles. The changes of ECG before and after anthracycline chemotherapy in patients with no abnormal ECG before and after chemotherapy were analyzed retrospectively. The abnormal changes of electrocardiogram (ECG) were regarded as diagnostic indexes of acute cardiac toxicity treated with anthracycline. The incidence of abnormal changes of ECG in patients with anthracycline chemotherapy and the change of QT interval QTc with the number of chemotherapy cycles were summarized. Compare the age of the patient, Body mass index (BMI), tumor TNM stage, history of hypertension and diabetes, combined radiotherapy. Whether there were significant differences in the types and cumulative doses of anthracyclines between patients with abnormal electrocardiogram and those without abnormal ECG, The risk factors of acute cardiac toxicity in breast cancer patients treated with anthracycline drugs were summarized by regression analysis. Of 253 patients, 92 had abnormal changes in electrocardiogram. The incidence of abnormal electrophysiological and rhythmic changes was 36.36. The incidence of abnormal electrophysiology and rhythm was 30.83.The order of incidence from high to low was St change of T wave, sinus tachycardia, sinus bradycardia, atrial premature contraction, ventricular premature contraction, abnormal Q wave. Atrioventricular block, right bundle branch block, QTc prolongation of borderline premature beat in 31 cases, The incidence rate was 12.25%. QTc1-4 cycle was prolonged by a large extent and the 5-8 cycles were prolonged with statistical significance. The difference was not statistically significant (P > 0.05). The difference between the cumulative dose and age of anthracycline after treatment with anthracycline. Further analysis showed that the age of patients was an independent risk factor of acute cardiac toxicity. For example, body mass index (BMI), tumor TNM stage, hypertension history, diabetes history, combined radiotherapy, There was no significant correlation between the types of anthracycline drugs and the abnormal changes of ECG. Conclusion: the incidence of acute cardiac toxicity events during the treatment of anthracycline drugs is higher. The main manifestations were the prolongation of QTc in electrophysiology and rhythm. QTc increased with the increase of anthracycline chemotherapy cycle. The age of patients and the cumulative dose of anthracycline drugs were correlated with acute cardiac toxicity. Patient age is an independent risk factor for acute cardiac toxicity of anthracyclines. Therefore, cardiac monitoring should be strengthened in elderly patients and the cumulative dose of anthracycline should be controlled within a safe range.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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