急性放射性心脏损伤的临床分析

发布时间：2018-02-27 18:26

本文关键词： 调强放射治疗放射性心脏损伤心电图心肌酶心肌肌钙蛋白I 彩色多普勒超声心动图剂量体积直方图　出处：《河北医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨胸部肿瘤放疗后心电图、心肌酶谱、血清心肌肌钙蛋白I（cTnI）、心脏功能改变及临床、物理等因素与急性放射性心脏损伤的相关性。方法：2011年11月至2012年12月序贯入组的首程放疗胸部肿瘤患者51例，其中肺癌25例（中央型24例，周围型1例），食管癌26例（胸上段5例，中段13例，下段8例），49例经病理证实，2例患者依据症状及影像学检查临床诊断为肺癌。均采用调强放疗方式，食管癌PTV处方剂量50-63Gy（中位剂量60Gy）,肺癌PTV处方剂量46.8-66Gy(中位剂量58Gy),1.8-2.1Gy/次/日，5次/周。所有患者均于放疗前、放疗结束及放疗后3个月行心电图、心肌酶谱、血清cTnI及彩色多普勒超声心动图检查，应用NCI-CTCAE3.0评价标准对急性放射性心脏损伤进行评价。探讨胸部肿瘤患者放疗后心电图、心肌酶谱、血清cTnI、心功能改变及临床、物理因素（性别、年龄、高血压病史、化疗、KPS评分、TNM分期、心脏Dmax、心脏Dmin、心脏Dmean、心脏D100~D10、心脏V5~V60）与急性射性心脏损伤的相关性。结果：本研究共发生急性放射性心脏损伤37例，总发生率为72.55%(37/51)，其中1级放射性心脏损伤34例，2级放射性心脏损伤2例，3级放射性心脏损伤1例，未发生3级以上放射性心脏损伤者。 1心电图与急性放射性心脏损伤： 21例患者出现心电图异常，其中窦性心动过速6例、房性或室性期前收缩6例，ST-T改变4例、左或右束支传导阻滞2例、左室高电压2例、窦性心动过缓1例。17例于放疗结束时即出现异常，3个月后复查，其中8例恢复正常，仍有9例异常（窦性心动过速3例、房性期前收缩1例，ST-T改变1例、左束支传导阻滞1例、窦性心动过缓1例、左室高电压2例），4例于放疗后3个月出现心电图异常（窦性心动过速2例、房性期前收缩2例）。 2心肌酶谱、血清cTnI与急性放射性心脏损伤： 11例患者出现心肌酶谱升高，5例患者出现cTnI升高。放疗前、放疗结束、放疗后3个月血清AST、CK、CK-MB、LDH、HBDH比较，血清AST、CK水平放疗结束时较放疗前降低，而放疗后3个月水平较放疗前有所升高（P＜0.05）。血清CK-MB水平放疗结束及疗后3个月较放疗前均降低。血清LDH、HBDH水平于放疗结束及放疗后3个月差异无统计学意义。放疗结束时血清cTnI水平较放疗前升高，而放疗后3个月血清cTnI水平有所降低（F=3.468,P=0.035）。 3心功能与急性放射性心脏损伤： 26例患者出现左心室收缩功能减低，8例患者出现左室舒张功能减低，3例患者出现心包积液。放射治疗前、放疗结束及放疗后3个月心功能各项指标相比，放疗前、放疗结束及放疗后3个月左室射血分数、短轴缩短率及E/A值差异有统计学意义(P均＜0.05)。放疗结束及放疗后3个月左室射血分数持续降低，短轴缩短率及E/A值于放疗结束时降低，放疗后3个月有所升高。 4物理、临床因素与急性放射性心脏损伤：损伤组与未损伤组患者物理因素差异无统计学意义（P＞0.05）。损伤组与未损伤组临床各因素比较均无统计学意义（P＞0.05）。单因素分析物理因素及临床因素，未发现放射性心脏损伤发生的影响因素。结论：急性放射性心脏损伤中心电图异常较为常见，，主要为窦性心动过速和期前收缩，放射线致心电图异常部分为可逆性的。血清AST、CK、 cTnI水平于放疗后均升高，其中血清cTnI更为敏感。放疗结束后即可出现左室收缩、舒张功能减低。未发现心脏剂量-体积参数及患者临床情况与急性放射性心脏损伤发生的相关性。
[Abstract]:Objective: To explore the correlation between electrocardiogram, myocardial enzyme spectrum, serum cardiac troponin I (cTnI), cardiac function changes, clinical and physical factors and acute radiation heart injury after radiotherapy for thoracic tumor.
Methods: 51 patients with primary radiotherapy of thoracic tumor from November 2011 to December 2012 order penetration group cases, including 25 cases of lung cancer (24 cases of central type, 1 cases of peripheral type), 26 cases of esophageal cancer (5 cases, 13 cases of middle upper thoracic segment, 8 cases), 49 cases were confirmed by pathology, 2 cases on the basis of the symptoms and imaging examination in clinical diagnosis of lung cancer. Using intensity-modulated radiotherapy, esophageal cancer PTV 50-63Gy prescription dose (median dose 60Gy), lung cancer PTV 46.8-66Gy prescription dose (median dose 58Gy), 1.8-2.1Gy/ times / day, 5 times a week. All patients before radiotherapy, radiotherapy and after radiotherapy 3 months for ECG, myocardial enzymes, serum cTnI and color Doppler echocardiography. The application of NCI-CTCAE3.0 evaluation criteria to evaluate the acute radiation-induced heart injury. To investigate the electrocardiogram in patients with chest tumor radiotherapy, myocardial enzymes, serum cTnI, heart function and clinical and physical factors (gender, year Age, history of hypertension, chemotherapy, KPS score, TNM staging, cardiac Dmax, cardiac Dmin, cardiac Dmean, cardiac D100~D10, cardiac V5~V60) and acute radiative cardiac injury.
Results: there were 37 cases of acute radiation-induced heart injury. The total incidence rate was 72.55% (37/51), including 1 cases of radiation-induced heart injury, 34 cases, 2 cases of radiation-induced heart injury 2 cases, 3 cases of radiation-induced heart injury 1 cases, and no more than 3 cases of radiation-induced heart injury.
1 electrocardiogram and acute radionuclide injury:
21 patients had ECG abnormalities, including 6 cases of sinus tachycardia, atrial or ventricular contractions in 6 cases, 4 cases of ST-T, 2 cases of left or right bundle branch block, 2 cases of left ventricular high voltage, sinus bradycardia in 1 cases of.17 patients at the end of radiotherapy appears abnormal, 3 months after the review, of which 8 cases returned to normal, there are still 9 cases of abnormal (3 cases of sinus tachycardia, 1 cases of atrial extrasystole, ST-T changes in 1 cases, 1 cases of left bundle branch block sinus bradycardia in 1 cases, 2 cases of left ventricular high voltage) in 4 cases, 3 months after radiotherapy of ECG abnormalities (2 cases of sinus tachycardia, 2 cases of atrial extrasystole).
2 myocardial enzyme spectrum, serum cTnI and acute radionuclide injury:
11 cases of patients with myocardial enzyme, 5 patients had elevated cTnI. Before radiotherapy, radiotherapy, radiotherapy 3 months after serum AST, CK, CK-MB, LDH, HBDH, serum AST, CK levels after radiotherapy decreased compared to that before radiotherapy and after radiotherapy, 3 months before radiotherapy level is rising high (P < 0.05). The level of serum CK-MB after radiotherapy and 3 months after treatment than before radiotherapy were decreased. The serum levels of LDH, there was no significant difference in HBDH Level 3 months after radiotherapy and after radiotherapy. The level of serum cTnI after radiotherapy was higher than before radiotherapy, and serum cTnI levels in 3 months to reduce radiotherapy after (F=3.468, P=0.035).
3 cardiac function and acute radionuclide injury:
26 cases of patients with left ventricular systolic dysfunction, 8 cases of patients with left ventricular diastolic dysfunction, 3 cases of patients with pericardial effusion. Before radiotherapy, radiotherapy and after radiotherapy in 3 months, the index of heart function before radiotherapy, radiotherapy and radiotherapy after 3 months of left ventricular ejection fraction, short axis shortening rate and E/A was statistically significant difference (P < 0.05). The end of radiotherapy and radiotherapy after 3 months of left ventricular ejection fraction decreased, shortening rate and E/A value to the end of radiotherapy decreased 3 months after radiotherapy was increased.
4 physical, clinical factors and acute radionuclide injury:
There was no significant difference in physical factors between the injury group and the non injury group (P > 0.05). There was no significant difference in the clinical factors between the injury group and the non injury group (P > 0.05).
Conclusion: acute central EEG abnormal radioactive heart injury is common, mainly for sinus tachycardia and premature contraction velocity, radiation induced abnormal ECG is reversible. Serum AST, CK, cTnI levels in serum were increased after radiotherapy, which is more sensitive to cTnI. After the end of radiotherapy can appear left ventricular systolic, no correlation of cardiac diastolic function decreased. Dose volume parameters and clinical situation of patients with acute radiation-induced heart injury was found.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R818.74

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