食管癌再程放疗剂量与心脏损伤的相关性研究

Study on correlation of heart injury and radioactive dose in second course of radiation on esophageal cancer

目的探讨食管癌再程放疗时放疗剂量与心脏放射性损伤的关系。方法将60例食管癌放疗后复发患者分为实验组和对照组,每组各30例,实验组采用放疗＋热疗,放疗剂量为4 500~5 000 cGy;对照组予单纯放疗,放疗剂量为6 000~6 500 cGy。观察2组放疗后不同时段的心电图及心肌酶变化。结果放疗结束及放疗后1,3,6个月心电图异常率实验组分别为61%（17/28）,57%（16/28）,59%（16/27）和36%（8/22）,对照组分别为70%（19/27）,67%（18/27）,64%（14/22）和79%（11/14）。2组放疗结束及放疗后1,3个月心电图异常比较无显著性差异（P均〉0.05）,放疗后6个月心电图异常比较有显著性差异（P〈0.05）。放疗结束及放疗后1,3,6个月心肌酶异常率实验组分别为14%（4/28）,11%（3/28）,11%（3/27）和41%（9/22）;对照组分别为26%（7/27）,19%（5/27）,18%（4/22）和29%（4/14）。2组放疗结束及放疗后1,3,6个月心肌酶异常率比较均无显著性差异（P均〉0.05）。结论放射性心脏损伤与放疗剂量呈正相关,心电图是较好的观察指标,而心肌酶反应较差。

Objective It is to approach the relation of heart injury and radioactive dose in second course of radiation on esophageal cancer.Methods 60 patients with recurrent esophageal carcinoma after radical radiotherapy were divided into 2 groups with 30 cases each other.The patients in experimental group were treated by thermotherapy combined with radiotherapy,the dose of radiotherapy was 4 500 to 5 000 cGy;the patients in control group were treated by radiotherapy with a dose of 6 000 to 6 500 cGy.The changes of ECG and myocardial enzymes were observed at different time.Results ECG abnormality within the first one,three and six months after radiotherapy was respectively 61%,57%,56% and 36% in experimental group and 70%,67%,64% and 79% in control group.The difference of ECG abnormality between two groups at one-month and three-month post-radiotherapy was not statistically significant（P0.05） while at six-month post-radiotherapy ECG abnormality was statistically significant（P0.05）.Myocardial enzymes abnormality within the first one,three and six months after radiotherapy was respectively 14%,11%,11% and 41% in experimental group and 26%,19%,18% and 29% in control group.The difference in the levels of myocardial enzyme between two groups was not statistically significant（P0.05）.Conclusion The heart injury has positive relativity with radioactive dose;ECG is the better index to observe than myocardial enzymes.