心电图QT间期离散度与超声心动图对阿霉素心肌病的早期预测价值

The Early Predictive Value of QT Interval Dispersion and Echocardiography in Patients With Epirubicin Cardiomyopathy

目的:探讨QT间期离散度和超声心动图预测阿霉素引起的早期心肌损伤的应用价值。方法:收集2012-01至2013-12期间在我院确诊并有明确病理分型的44例乳腺癌患者,且均采用含蒽环类药物的方案化疗,表阿霉素应用剂量为75mg/m^2,进行1~5个化疗周期,随着化疗进程,体内阿霉素累积剂量不同,动态监测心电图QT间期离散度及心脏超声心动图变化并进行分析。结果:每个疗程化疗后QT间期离散度分别为40.00(40.00,50.00)ms、42.50(30.75,60.00)ms、45.00(35.00,50.00)ms、40.00(35.00,55.00)ms、45.00(30.00,70.00)ms,较应用表阿霉素前基线水平32.50(25.00,40.00)ms均明显延长(P均<0.05),差异有统计学意义。每个疗程化疗后左心室舒张末期内径较应用表阿霉素前基线水平呈轻度增大趋势、左心室射血分数和左心室缩短分数呈轻度下降趋势,但差异均无统计学意义(P均>0.05)。结论:心电图QT间期离散度用于评价阿霉素心肌病较心脏超声心动图的左心室舒张末期内径、左心室射血分数和左心室缩短分数更为敏感。通过监测心电图QT间期离散度变化,从而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。

Objective： To explore the early predictive value and sensitivity of QT interval dispersion and echocardiography in patients with epirubicin cardiomyopathy. Methods： A total of 44 patients with confirmed diagnosis of breast cancer treated in our hospital from 2012-01 to 2013-12 were studied. All patients received chemotherapy with anthracycline for 1-5 cycles, and the dose of epidoxorubicina was 75 mg/m^2. With different dose of epirubicin accumulated by chemotherapy in vivo, the changes of QT interval dispersion and echocardiography were examined and analyzed to study the cardiac injury in those patients. Results： Compared with the baseline QT interval dispersion at 32.5 （25.00, 40.00） ms, the QT interval dispersion after each chemotherapy cycle were at 40.00 （40.00, 50.00） ms, 42.50 （30.75, 60.00） ms, 45.00 （35.00, 50.00 ） ms, 40.00 （35.00, 55.00） ms and 45.00 （30.00, 70.00） ms respectively, they were all longer than the baseline, P〈0.05. Echocardiography indicated that after each chemotherapy cycle, left ventricular end-diastolic diameter （LVEDD） was slightly increased, while LVEF and LVFS were slightly decreased, P〉0.05. Conclusion： QT interval dispersion of ECG is more sensitive for evaluating the patients with epirubicin cardiomyopathy than the indexes of LVEDD, LVEF and LVFS by echocardiography. ECG monitoring of QT interval dispersion in chemotherapy patients may ifnd the early toxic cardiac injury at subclinical stage in relevant patients.