血脑钠肽及肌钙蛋白Ⅰ水平与胸部放疗后放射性心脏损伤发生率的关系
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摘要
目的:探讨胸部恶性肿瘤放射治疗患者血清脑钠肽(BNP)和肌钙蛋白Ⅰ(cTnⅠ)水平与放射性心脏损伤(RⅠHD)发生的相关性。方法:对60例胸部恶性肿瘤患者采用三维适形放疗;放疗前、放疗6周和放疗3个月检测血清cTnⅠ和BNP水平。结果:RⅠHD 43例(71.7%),1级RⅠHD 40例,2级RⅠHD 3例;心电图异常22例中17例于放疗结束后即出现异常,5例于放疗3个月后出现异常。患者血清BNP和cTnⅠ水平在放疗第6周发生显著上升,放疗后3个月回落,放疗第6周BNP和cTnⅠ水平均显著高于放疗前和放疗后3个月(P<0.05);放疗第6周RⅠHD组cTnⅠ和BNP水平均显著高于无RⅠHD组(P<0.05),与放疗前比较RⅠHD组BNP显著上升(P<0.05)。结论:RⅠHD患者血清BNP和cTnⅠ水平在放疗早期显著升高,两者可作为潜在早期预测指标。
Objective: To study the correlation between serum cTnⅠ,BNP and radiation-indaced heart diseases( RIHD) in patients with chest malignant tumor radiotherapy. Methods: Three dimensional conformal radiotherapy was used in 60 patients with malignant tumor in chest. The serum levels of cTnⅠ and BNP were detected before radiotherapy,6 weeks of radiotherapy and 3 months of radiotherapy. Results: There were 43 cases of RIHD( 71. 7%),in which 40 cases was grade 1,3 cases was grade 2. There were 22 cases of abnormal electrocardiogram,17 cases happened after radiotherapy,5 cases happened after 3 months of radiotherapy. The serum cTnⅠ and BNP in the sixth week of radiotherapy rose significantly,then decreased 3 months after radiotherapy,cTnⅠ and BNP six weeks after radiotherapy were significantly higher than that of 3 months before and after radiotherapy( P < 0. 05); having in the RIHD group radiotherapy for sixth weeks BNP and cTnⅠ were significantly higher than that of non RIHD group; compared with RIHD group before radiotherapy,BNP increased significantly( P < 0. 05). Conclusion:The plasma levels of BNP and cTnⅠ in patients with RIHD are significantly increased at the early stage of radiotherapy. BNP and cTnⅠ could be used as a potential early predictor.
Objective: To study the correlation between serum cTnⅠ,BNP and radiation-indaced heart diseases( RIHD) in patients with chest malignant tumor radiotherapy. Methods: Three dimensional conformal radiotherapy was used in 60 patients with malignant tumor in chest. The serum levels of cTnⅠ and BNP were detected before radiotherapy,6 weeks of radiotherapy and 3 months of radiotherapy. Results: There were 43 cases of RIHD( 71. 7%),in which 40 cases was grade 1,3 cases was grade 2. There were 22 cases of abnormal electrocardiogram,17 cases happened after radiotherapy,5 cases happened after 3 months of radiotherapy. The serum cTnⅠ and BNP in the sixth week of radiotherapy rose significantly,then decreased 3 months after radiotherapy,cTnⅠ and BNP six weeks after radiotherapy were significantly higher than that of 3 months before and after radiotherapy( P < 0. 05); having in the RIHD group radiotherapy for sixth weeks BNP and cTnⅠ were significantly higher than that of non RIHD group; compared with RIHD group before radiotherapy,BNP increased significantly( P < 0. 05). Conclusion:The plasma levels of BNP and cTnⅠ in patients with RIHD are significantly increased at the early stage of radiotherapy. BNP and cTnⅠ could be used as a potential early predictor.
引文
[1]王棉,龙书敬,王军.放射性心脏损伤研究进展[J].中华肿瘤防治杂志,2015,22(13):1068-1072.
[2]熊乐,刘安文.放射性心脏损伤的病理基础及生物学机制[J].肿瘤防治研究,2017,44(1):66-68.
[3]TAPIO S.Pathology and biology of radiation-induced cardiac disease[J].J Radiat Res,2016,57(5):439-448.
[4]TROTT K R.Some considerations for future research into the risks of radiation-induced cardiovascular diseases[J].Strahlenther Onkol,2016,192(11):747-749.
[5]TROTT K R.Some considerations for future research into the risks of radiation-induced cardiovascular diseases[J].Strahlenther Onkol,2016,192(11):747-749.
[6]武亚晶,王军,王韩.放射性心脏损伤发病机制研究进展[J].中华放射肿瘤学杂志,2016,25(6):657-660.
[7]LIEBLONG B,BHATTI S,MULKRY R,et al.Dobutamine stress testing as an early diagnostic for radiation-induced heart disease[J].Faseb,2015,29(1):942-943.
[8]OGINO I,WATANABE S,IWAHASHI N,et al.Symptomatic radiation-induced cardiac disease in long-term survivors of esophageal cancer[J].Strahlenther Onkol,2016,192(6):1-9.
[9]王祎,王军,程云杰,等.血清细胞因子TGF-β1和IL-1β表达水平对急性放射性心脏损伤发生的影响[J].中华放射医学与防护杂志,2012,32(5):488-491.
[10]刘青,王军,关嵩,等.基础心功能状况与急性放射性心脏损伤的相关性研究[J].中华放射医学与防护杂志,2015,35(11):825-829.
[11]龙书敬,王军,王祎,等.急性放射性心脏损伤不同分级标准比较研究[J].中华肿瘤防治杂志,2014,21(6):469-472.
[12]吕鹏,臧爱民.血清肌钙蛋白I在放射性心脏损伤中的变化及右丙亚胺对其影响[J].长治医学院学报,2013,27(2):94-96.
[13]符天晓,周菊英,焦旸.C57BL/6小鼠放射性心脏损伤动物模型的建立及血清标志物的探讨[J].安徽医科大学学报,2015,50(7):922-925.
[14]陈学,龙静,韩朝辉,等.和肽素脑钠肽及高敏肌钙蛋白T在急性心肌梗死中的早期诊断价值[J].中国急救医学,2016,36(7):634-638.
[15]孙红.N-末端脑钠肽前体及心肌肌钙蛋白I与慢性心力衰竭的关系[J].中国中西医结合急救杂志,2011,18(4):235-236.
[16]黄晓玲,陈柏梁,仇烨,等.血清肌钙蛋白I、血浆脑钠肽联合心脏Tei指数评估窒息新生儿心肌损伤及心功能[J].中华实用儿科临床杂志,2014,29(14):1112-1114.
[17]刘进军,吴士礼,王本芳,等.急性心肌梗死患者血清生长分化因子15、肌钙蛋白及脑钠肽的表达及其临床意义[J].实用医学杂志,2012,28(13):2190-2192.
[18]秦娟,何雅军.肌钙蛋白T及肌红蛋白和脑钠肽前体联合检测在急性心肌梗死诊断中的应用[J].广东医学,2012,33(16):2415-2417.
[19]王军,王祎,刘青,等.三维放疗急性放射性心脏损伤类型及影响因素分析[J].中华放射肿瘤学杂志,2013,22(3):213-216.
[2]熊乐,刘安文.放射性心脏损伤的病理基础及生物学机制[J].肿瘤防治研究,2017,44(1):66-68.
[3]TAPIO S.Pathology and biology of radiation-induced cardiac disease[J].J Radiat Res,2016,57(5):439-448.
[4]TROTT K R.Some considerations for future research into the risks of radiation-induced cardiovascular diseases[J].Strahlenther Onkol,2016,192(11):747-749.
[5]TROTT K R.Some considerations for future research into the risks of radiation-induced cardiovascular diseases[J].Strahlenther Onkol,2016,192(11):747-749.
[6]武亚晶,王军,王韩.放射性心脏损伤发病机制研究进展[J].中华放射肿瘤学杂志,2016,25(6):657-660.
[7]LIEBLONG B,BHATTI S,MULKRY R,et al.Dobutamine stress testing as an early diagnostic for radiation-induced heart disease[J].Faseb,2015,29(1):942-943.
[8]OGINO I,WATANABE S,IWAHASHI N,et al.Symptomatic radiation-induced cardiac disease in long-term survivors of esophageal cancer[J].Strahlenther Onkol,2016,192(6):1-9.
[9]王祎,王军,程云杰,等.血清细胞因子TGF-β1和IL-1β表达水平对急性放射性心脏损伤发生的影响[J].中华放射医学与防护杂志,2012,32(5):488-491.
[10]刘青,王军,关嵩,等.基础心功能状况与急性放射性心脏损伤的相关性研究[J].中华放射医学与防护杂志,2015,35(11):825-829.
[11]龙书敬,王军,王祎,等.急性放射性心脏损伤不同分级标准比较研究[J].中华肿瘤防治杂志,2014,21(6):469-472.
[12]吕鹏,臧爱民.血清肌钙蛋白I在放射性心脏损伤中的变化及右丙亚胺对其影响[J].长治医学院学报,2013,27(2):94-96.
[13]符天晓,周菊英,焦旸.C57BL/6小鼠放射性心脏损伤动物模型的建立及血清标志物的探讨[J].安徽医科大学学报,2015,50(7):922-925.
[14]陈学,龙静,韩朝辉,等.和肽素脑钠肽及高敏肌钙蛋白T在急性心肌梗死中的早期诊断价值[J].中国急救医学,2016,36(7):634-638.
[15]孙红.N-末端脑钠肽前体及心肌肌钙蛋白I与慢性心力衰竭的关系[J].中国中西医结合急救杂志,2011,18(4):235-236.
[16]黄晓玲,陈柏梁,仇烨,等.血清肌钙蛋白I、血浆脑钠肽联合心脏Tei指数评估窒息新生儿心肌损伤及心功能[J].中华实用儿科临床杂志,2014,29(14):1112-1114.
[17]刘进军,吴士礼,王本芳,等.急性心肌梗死患者血清生长分化因子15、肌钙蛋白及脑钠肽的表达及其临床意义[J].实用医学杂志,2012,28(13):2190-2192.
[18]秦娟,何雅军.肌钙蛋白T及肌红蛋白和脑钠肽前体联合检测在急性心肌梗死诊断中的应用[J].广东医学,2012,33(16):2415-2417.
[19]王军,王祎,刘青,等.三维放疗急性放射性心脏损伤类型及影响因素分析[J].中华放射肿瘤学杂志,2013,22(3):213-216.