Q-T间期离散度和心脏超声对蒽环类药物早期心肌损伤的预测价值

Predictive value of QT interval dispersion and echocardiography in early myocardium injury induced by anthracycline

关键词:  Q-T间期离散度  心脏超声  蒽环类药物  早期心肌损伤

Key words:  [Key words]　QT interval dispersion  echocardiography  anthracycline  early myocardial injury

摘要:

目的　探讨Q-T间期离散度和心脏超声对预测蒽环类药物引起的早期心肌损伤的敏感性及应用价值。方法　入选29例乳腺癌患者，且均采用含蒽环类药物的方案化疗，应用表阿霉素剂量为75 mg /m2 ，进行2~6个周期，随化疗进行体内蒽环类药物累积剂量不同，动态监测心电图Q-T间期离散度及心脏超声变化，并进行分析与评价。结果　化疗后Q-T间期离散度较化疗前明显延长,差异有显著性意义，P<0.001。化疗后左室舒张末期前后径较化疗前轻度增大、左室射血分数较化疗前轻度下降，但差异无显著性意义，P>0.05。结论　化疗药物对心肌损伤的评价指标中，心电图Q-T间期离散度较心脏超声的左室舒张末期前后径和左室射血分数更为敏感，具有对蒽环类药物引起的心肌损伤的早期预测价值，通过监测心电图Q-T间期离散度变化，能及早在心肌损伤亚临床阶段发现其心脏毒性的发生与进展。

Abstract:

[Abstract] Objective　To discuss the application value and sensitivity of QT interval dispersion and echocardiography in early myocardium injury induced by anthracycline. Methods　The study included 29 breast cancer patients, who received chemotherapy with anthracycline，The dosage of epidoxorubicina was 75 mg/m2 for 2-6 cycles. QT interval dispersion by ECG and echocardiography were analyzed in accordance with the accumulation of anthracycline by chemotherapy. Results　Q-T interval dispersion became longer after chemotherapy compared to that before chemotherapy. The differences were statistically significant (P<0.001). After chemotherapy, the left ventricular end-diastolic diameter increased slightly and LVEF decreased slightly, but there were no statistical differences compared to those before chemotherapy (P>0.05). Conclusion　Among the indexes of myocardium injury induced by chemotherapy drugs, Q-T interval dispersion is more sensitive than left ventricular end-diastolic diameter and LVEF by echocardiography, and can be a useful marker for early prediction of anthracycline-induced myocardium injury. We can discover the early occurrence and progress of cardiac toxicity in subclinical stage through monitoring the Q-T dispersion changes.