化疗期间心电图异常对蒽环类药物引起乳腺浸润性导管癌患者慢性心脏毒性的预测价值
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摘要
目的研究化疗期间心电图异常对蒽环类药物引起乳腺浸润性导管癌患者慢性心脏毒性的预测价值。方法收集郑州大学第二附属医院乳腺外科2013年5月—2015年5月收治的经病理检查确诊为乳腺浸润性导管癌患者123例。根据随访期间是否发生心脏毒性分为心脏毒性组21例和无心脏毒性组102例。观察两组心电图检查结果,分析乳腺浸润性导管癌化疗后发生慢性心脏毒性的影响因素。结果两组年龄比较,差异有统计学意义(P<0.05);心脏毒性组心电图异常、ST-T段改变、T波异常发生率高于非心脏毒性组(P<0.05);心脏毒性组心电图异常次数多于非心脏毒性组(P<0.05)。多因素Logistic回归分析显示,年龄、心电图异常次数、ST-T段改变、T波异常是乳腺浸润性导管癌化疗后慢性心脏毒性的影响因素(P<0.05)。结论女性乳腺浸润性导管癌的年龄、化疗期间心电图异常与慢性心脏毒性发生有一定相关性,对早期预防和治疗化疗引起的慢性心脏毒性有重要的临床指导意义。
Objective To investigate the value of electrocardiogram( ECG) abnormalities in predicting chronic cardiotoxicity induced by anthracycline chemotherapy in invasive breast ductal carcinoma patients. Methods This study enrolled123 consecutive patients,who were admitted to Department of Breast Surgery of the Second Affiliated Hospital of Zhengzhou University from May 2013 to May 2015 and diagnosed with invasive breast ductal carcinoma confirmed pathologically. According to cardiotoxicity during follow- up,they were divided into cardioxicity group( n = 21) and non- cardioxicity group( n = 102).The ECG consequence between the two groups were observed, the influnce factor of chronic cardiotoxicity occured after chemotherapy of invasive breast ductal carcinoma patients. Results Significant difference in age was found between the two groups( P < 0. 05). Compared with the non- cardioxicity group,the cardioxicity group had a higher percentage of ECG,ST-T segment and T- wave abnormalities during chemotherapy( P < 0. 05). ECG abnormalities occurred more frequently in the cardioxicity group than in the non- cardioxicity group( P < 0. 05). Multivariate Logistic regression analysis found that age,frequency of ECG abnormalities,ST- T segment and T- wave abnormalities were correlation factors for chronic cardioxicity in invasive breast ductal carcinoma after chemotherapy( P < 0. 05). Conclusion Age and ECG abnormalities occurred during anthracycline chemotherapy, have a clear relationship with the chronic cardioxicity in women with invasive breast ductal carcinoma. This has tremendous clinical significance in the early prevention and treatment of chronic cardioxicity due to chemotherapy.
Objective To investigate the value of electrocardiogram( ECG) abnormalities in predicting chronic cardiotoxicity induced by anthracycline chemotherapy in invasive breast ductal carcinoma patients. Methods This study enrolled123 consecutive patients,who were admitted to Department of Breast Surgery of the Second Affiliated Hospital of Zhengzhou University from May 2013 to May 2015 and diagnosed with invasive breast ductal carcinoma confirmed pathologically. According to cardiotoxicity during follow- up,they were divided into cardioxicity group( n = 21) and non- cardioxicity group( n = 102).The ECG consequence between the two groups were observed, the influnce factor of chronic cardiotoxicity occured after chemotherapy of invasive breast ductal carcinoma patients. Results Significant difference in age was found between the two groups( P < 0. 05). Compared with the non- cardioxicity group,the cardioxicity group had a higher percentage of ECG,ST-T segment and T- wave abnormalities during chemotherapy( P < 0. 05). ECG abnormalities occurred more frequently in the cardioxicity group than in the non- cardioxicity group( P < 0. 05). Multivariate Logistic regression analysis found that age,frequency of ECG abnormalities,ST- T segment and T- wave abnormalities were correlation factors for chronic cardioxicity in invasive breast ductal carcinoma after chemotherapy( P < 0. 05). Conclusion Age and ECG abnormalities occurred during anthracycline chemotherapy, have a clear relationship with the chronic cardioxicity in women with invasive breast ductal carcinoma. This has tremendous clinical significance in the early prevention and treatment of chronic cardioxicity due to chemotherapy.
引文
[1]中国临床肿瘤学会.蒽环类药物心脏毒性防治指南(2013年版)[J].临床肿瘤学杂志,2013,18(10):925-934.The Chinese Society of Clinical Oncology.The Prevention and Treatment Guidelines of Anthracycline Drugs Chronic Cardiotoxity(2013)[J].Chinese Clinical Oncology,2013,18(10):925-934.
[2]KOITABASHI N,OHYAMA Y,TATENO R,et al.Reversible cardiomyopathy after epirubicin administration[J].Int Heart J,2015,56(4):466-468.
[3]ELME A,SAARTO T,TTTERMAN K J,et al.Electrocardiography changes during adjuvant breast cancer therapy:incidence and risk factors[J].Anticancer Res,2013,10(33):4933-4940.
[4]YEH E T,BICKFORD C L.Cardiovascula rcomplications of cancer therapy:incidence,pathogenesis,diagnosis,and management[J].J Am Coll Cardiol,2009,53(24):2231-2247.
[5]BARRETT-LEE P J,DIXON J M,FARRELL C,et al.Expert opinion on the use of anthracyclines in patients with advanced breast cancer at cardiac risk[J].Ann Oncol,2009,20(5):816-827.
[6]THEODOULOU M,SEIDMAN A D.Cardiac effects of adjuvant therapy for early breast cancer[J].Semin Oncol,2003,30(6):730-739.
[7]HORACEK J M,JAKL M,HORACKOVA J,et al.Assessment of anthracycline-induced cardiotoxicity with electrocardiography[J].Exp Oncol,2009,31(2):115-117.
[8]张剑辉,回天立,栾士超,等.蒽环类化疗药物治疗乳腺癌的毒性及其防治[J].实用癌症杂志,2015,30(7):1041-1043.ZHANG J H,HUI T L,LUAN S C,et al.Anthracycline in the treatment and prevention of toxicity of breast cancer[J].The Practical Journal of Cancer,2015,30(7):1041-1043.
[9]顾晓怡,姜藻,董丽钧.参芪扶正液抗蒽环类化疗药物所致心脏毒性的作用[J].东南大学学报(医学版),2008,27(5):375-377.GU X Y,JIANG Z,DONG L J.Heartprotection of parenteral solution Shenqifuzheng in the chemotherapy with marcellomycin[J].Journal of Southeast University(Medical Science Edition),2008,27(5):375-377.
[10]FUMOLEAU P,ROCHH,KERBRAT P,et al.Long-term cardiac toxicity after adjuvant epirubicin-based chemotherapy in early breast cancer:french adjuvant study group results[J].Ann Oncol,2006,17(1):85-92.
[11]杨志军,陈磊.乳腺癌化疗前后心电图对比分析[J].实用心电学杂志,2010,19(4):294.YANG Z J,CHEN L.Comparison of electrocardiogram before and after chemotherapy with the breast cancer[J].Journal of Practical Electrocardiology JS,2010,19(4):294.
[12]AMMAR El-SM,SAID S A,SUDDEK G M,et al.Amelioration of doxorubicin-induced cardiotoxicity by deferiprone in rats[J].Can J Physiol Pharmacol,2011,89(4):269-276.
[13]程志祥,鲁翔.抗肿瘤药物对老年人的心脏毒性作用及防治方法[J].实用老年医学,2014,28(4):334-337.CHENG Z X,LU X.The effect and method of anticancer drugs for the elderly heart toxic[J].Pract Geriatr,2014,28(4):334-337.
[14]VALCOVICI M,ANDRICA F,SERBAN C,et al.Cardiotoxicity of anthracycline therapy:current perspectives[J].Arch Med Sci,2016,12(2):428-435.
[15]丁欣,丁国林.中年人非特异性ST-T改变120例临床观察和诊断价值探讨[J].吉林医学,2006,27(1):74.DING X,DING G L.The value of the ST-segment of the middleaged man in diagnosing and clinical research[J].Jilin Medical Journal,2006,27(1):74.
[16]钱敏.心电图T波改变的诊断与临床意义[J].中国疗养医学,2014,23(8):684-687.QIAN M.The diagnosic and clinical significance of the T-wave anomaly[J].Chin J Convalescent Med,2014,23(8):684-687.
[17]SALAZAR-MENDIGUCHA J,GONALEZ-COSTELLO J,ROCA J,et al.Anthracycline-mediated,cardiomyopathy:basic molecular knowledge for the cardiologist[J].Arch Cardiol Mex,2014,84(3):218-223.
[18]张小霞,刘仁光.心电图T波形成机制及异常的临床意义[J].北京医学,2012,34(7):605-607.ZHANG X X,LIU R G.The clinical significance and mechanism of the T-wave[J].Beijing Medical Journal,2012,34(7):605-607.
[19]赵静,陈晨.超声心动图与心电图对乳腺癌患者综合治疗后心脏损伤的评估[J].中国全科医学,2015,18(35):4313-4316.DOI:10.3969/j.issn.1007-9572.2015.35.010.ZHAO J,CHEN C.Evaluation of heart injury after the comprehensive treatment of patients with breast cancer by ultrasonic cardiogram and electrocardiogram[J].Chinese General Practice,2015,18(35):4313-4316.DOI:10.3969/j.issn.1007-9572.2015.35.010.
[20]张艳,宋兵蕾,白梅英,等.动态心电图、平板运动试验与常规心电图对无症状心肌缺血的诊断价值比较[J].中国煤炭工业医学杂志,2014,17(12):1932-1934.DOI:10.11723/mtgyyx 1007-9564 201412013.ZHANG Y,SONG B L,BAI M Y,et al.Values of applying dynamic electrocardiogram,treadmill exercise test and rountine electrocardiogram in the diagnosis of silent myocardial ischemia[J].Chinese Journal of Coal Industry Medicine,2014,17(12):1932-1934.DOI:10.11723/mtgyyx 1007-9564 201412013.
[21]FENG Y Y,YANG Z J.Clinical application of the heart rate deceleration capacity test to predict epirubicin-induced cardiotoxicity[J].J Cardiovasc Pharmacol,2015,66(4):371-375.
[2]KOITABASHI N,OHYAMA Y,TATENO R,et al.Reversible cardiomyopathy after epirubicin administration[J].Int Heart J,2015,56(4):466-468.
[3]ELME A,SAARTO T,TTTERMAN K J,et al.Electrocardiography changes during adjuvant breast cancer therapy:incidence and risk factors[J].Anticancer Res,2013,10(33):4933-4940.
[4]YEH E T,BICKFORD C L.Cardiovascula rcomplications of cancer therapy:incidence,pathogenesis,diagnosis,and management[J].J Am Coll Cardiol,2009,53(24):2231-2247.
[5]BARRETT-LEE P J,DIXON J M,FARRELL C,et al.Expert opinion on the use of anthracyclines in patients with advanced breast cancer at cardiac risk[J].Ann Oncol,2009,20(5):816-827.
[6]THEODOULOU M,SEIDMAN A D.Cardiac effects of adjuvant therapy for early breast cancer[J].Semin Oncol,2003,30(6):730-739.
[7]HORACEK J M,JAKL M,HORACKOVA J,et al.Assessment of anthracycline-induced cardiotoxicity with electrocardiography[J].Exp Oncol,2009,31(2):115-117.
[8]张剑辉,回天立,栾士超,等.蒽环类化疗药物治疗乳腺癌的毒性及其防治[J].实用癌症杂志,2015,30(7):1041-1043.ZHANG J H,HUI T L,LUAN S C,et al.Anthracycline in the treatment and prevention of toxicity of breast cancer[J].The Practical Journal of Cancer,2015,30(7):1041-1043.
[9]顾晓怡,姜藻,董丽钧.参芪扶正液抗蒽环类化疗药物所致心脏毒性的作用[J].东南大学学报(医学版),2008,27(5):375-377.GU X Y,JIANG Z,DONG L J.Heartprotection of parenteral solution Shenqifuzheng in the chemotherapy with marcellomycin[J].Journal of Southeast University(Medical Science Edition),2008,27(5):375-377.
[10]FUMOLEAU P,ROCHH,KERBRAT P,et al.Long-term cardiac toxicity after adjuvant epirubicin-based chemotherapy in early breast cancer:french adjuvant study group results[J].Ann Oncol,2006,17(1):85-92.
[11]杨志军,陈磊.乳腺癌化疗前后心电图对比分析[J].实用心电学杂志,2010,19(4):294.YANG Z J,CHEN L.Comparison of electrocardiogram before and after chemotherapy with the breast cancer[J].Journal of Practical Electrocardiology JS,2010,19(4):294.
[12]AMMAR El-SM,SAID S A,SUDDEK G M,et al.Amelioration of doxorubicin-induced cardiotoxicity by deferiprone in rats[J].Can J Physiol Pharmacol,2011,89(4):269-276.
[13]程志祥,鲁翔.抗肿瘤药物对老年人的心脏毒性作用及防治方法[J].实用老年医学,2014,28(4):334-337.CHENG Z X,LU X.The effect and method of anticancer drugs for the elderly heart toxic[J].Pract Geriatr,2014,28(4):334-337.
[14]VALCOVICI M,ANDRICA F,SERBAN C,et al.Cardiotoxicity of anthracycline therapy:current perspectives[J].Arch Med Sci,2016,12(2):428-435.
[15]丁欣,丁国林.中年人非特异性ST-T改变120例临床观察和诊断价值探讨[J].吉林医学,2006,27(1):74.DING X,DING G L.The value of the ST-segment of the middleaged man in diagnosing and clinical research[J].Jilin Medical Journal,2006,27(1):74.
[16]钱敏.心电图T波改变的诊断与临床意义[J].中国疗养医学,2014,23(8):684-687.QIAN M.The diagnosic and clinical significance of the T-wave anomaly[J].Chin J Convalescent Med,2014,23(8):684-687.
[17]SALAZAR-MENDIGUCHA J,GONALEZ-COSTELLO J,ROCA J,et al.Anthracycline-mediated,cardiomyopathy:basic molecular knowledge for the cardiologist[J].Arch Cardiol Mex,2014,84(3):218-223.
[18]张小霞,刘仁光.心电图T波形成机制及异常的临床意义[J].北京医学,2012,34(7):605-607.ZHANG X X,LIU R G.The clinical significance and mechanism of the T-wave[J].Beijing Medical Journal,2012,34(7):605-607.
[19]赵静,陈晨.超声心动图与心电图对乳腺癌患者综合治疗后心脏损伤的评估[J].中国全科医学,2015,18(35):4313-4316.DOI:10.3969/j.issn.1007-9572.2015.35.010.ZHAO J,CHEN C.Evaluation of heart injury after the comprehensive treatment of patients with breast cancer by ultrasonic cardiogram and electrocardiogram[J].Chinese General Practice,2015,18(35):4313-4316.DOI:10.3969/j.issn.1007-9572.2015.35.010.
[20]张艳,宋兵蕾,白梅英,等.动态心电图、平板运动试验与常规心电图对无症状心肌缺血的诊断价值比较[J].中国煤炭工业医学杂志,2014,17(12):1932-1934.DOI:10.11723/mtgyyx 1007-9564 201412013.ZHANG Y,SONG B L,BAI M Y,et al.Values of applying dynamic electrocardiogram,treadmill exercise test and rountine electrocardiogram in the diagnosis of silent myocardial ischemia[J].Chinese Journal of Coal Industry Medicine,2014,17(12):1932-1934.DOI:10.11723/mtgyyx 1007-9564 201412013.
[21]FENG Y Y,YANG Z J.Clinical application of the heart rate deceleration capacity test to predict epirubicin-induced cardiotoxicity[J].J Cardiovasc Pharmacol,2015,66(4):371-375.