急性淋巴细胞白血病患儿柔红霉素化疗心脏毒性反应的观察

Observation on the toxicity of daunorubicin to heart of acute lymphoblastic childhood leukemia

目的观察柔红霉素(DNR)对急性淋巴细胞白血病(ALL)化疗患儿的心脏毒性反应。方法回顾性分析92例接受DNR治疗的ALL患儿的资料,分析化疗后出现心脏毒性反应患儿的临床特点、ECG、24h动态心电图、心肌酶谱、心肌肌钙蛋白I(cTnI)、B型利钠肽(BNP)、超声心动图变化,按药物累积量进行分组分析,并对此类患儿应用心脏保护剂及换用替代药物去甲氧柔红霉素进行防治后跟踪随访。结果 92例患儿中有7例出现心脏毒性反应,主要表现为心律失常、心功能不全。经暂停化疗并加强防治后,心脏损害均得到改善。结论治疗ALL患儿时,应采用有效监测方法,定期对心脏进行毒性监测,及时控制柔红霉素累积剂量,并采取有效防治措施以减少心脏损伤。

Objective To investigate the daunorubicin-induced cardiotoxicity in the treatment of pediatric acute lympho- blastic leukemia. Methods We analysed retrospectively 92 cases of acute lumphocytic leukaemia （ALL） that were treated with DNR, chose the children with cardiotoxicity, analyzed the clinical characteristic, the ECG, the 24 h Holter, the cardiac muscle enzyme, the cTnI, the BNP and echocardiography. We divided them into grouPs and analyzing according to clinical types and accumulated doses. We cured them with protective medicine and replaced with idarubicin, and followed up of them. Results Seven of the 92 cases showed cardiotoxicity which almost had different type of arrhythmic or abnormal ECG and two had conges- tive heart. They all improved in health with protect and cure. Conclusion For the children with ALL treated with DNR, accu- mulated doses should be reasonably controlled, and drug toxicity monitoring should be done regularly. Long-term follow-up is needed so that heart injury can be detected promptly.