亚砷酸治疗急性早幼粒细胞白血病引发心肌损害的评价指标

Evaluation of indexes on myocardial damage induced by Arsenite in treatment of acute promyelocytic leukemia

目的探讨亚砷酸治疗急性早幼粒细胞白血病（ALP）引发心肌损害的评价指标。方法选取牡丹江市第一人民医院2011年1月-2014年6月经亚砷酸治疗的ALP患者60例,根据心肌损害发生情况分为两组,22例未发生心肌损害患者作为A组,38例发生心肌损害患者作为B组,选取同期体检人员60例为正常对照组。三组患者用药前,均行临床症状、心电图（QTC）动态观察,同时检测肌钙蛋白I（TnI）、血红蛋白、血钾、血镁等指标。A组与B组患者于用药1、2、3、4、5周再次检测这些指标。结果 60例ALP患者中心肌损害发生率为63.33%。治疗前,A组与B组患者血红蛋白明显低于正常对照组,心电图（QTC）明显高于正常对照组（P〈0.05）。A组患者用药过程中TnI、心率、血红蛋白、心电图（QTC）、血钾、血镁变化平稳,未见异常波动。B组患者用药1周时TnI、心率、心电图（QTC）、血镁显著增加,用药2周时均升至最高点,用药3周时开始下降,随着用药时间延长,逐渐降低;用药1周时血红蛋白、血钾显著降低,用药2周时均降至最低点,用药3周时开始升高,且随着用药时间延长,逐渐增加。B组患者用药1、2、3、4、5周时TnI、心率、心电图（QTC）明显高于A组,而血红蛋白明显低于A组。B组患者用药1、2、3周时血镁明显高于A组,而血钾明显低于A组（P〈0.05）。结论亚砷酸治疗ALP引发心肌损害的评价指标较多,心肌损害患者TnI会异常升高,可作为指导临床诊治的有效指标。

Objective To investigate evaluation indexes of myocardial damage induced by Arsenite in treatment of acute promyelocytic leukemia. Methods 60 patients treated with Arsenite of acute promyelocytic leukemia were selected in the First People＇s Hospital of Mudanjiang City from January 2011 to June 2014. They were divided into two groups according to myocardial damage, 22 patients did not happen myocardial damage as group A and 38 patients happened myocardial damage as group B and 60 healthy people were selected at same period as control group. Before treatment,clinical symptoms and ECG were observed and TnI, hemoglobin, serum potassium, serum magnesium were detected. 1,2, 3, 4, 5 weeks after treatment, these indexs of group A and B were treated again. Results Incidence of myocardial damage was 63.33% in 60 patients with ALP. Before treatment, hemoglobin in group A and B was significantly lower than control group while electrocardiogram was significantly higher than control group（P〈0.05）. In group A, TnI,heart rate, hemoglobin, electrocardiogram, serum potassium and magnesium changed smoothly during treatment and did not abnormally fluctuate. In group B, TnI, heart rate, electrocardiogram increased significantly 1 week after treatment and reached the highest point at 2 weeks after treatment, and decreased at 3 weeks, with the extension of treatment,they gradually reduced. In group B, hemoglobin, serum potassium decreased significantly 1 week after treatment, while reached the lowest 2 weeks after treatment, and then increased after 3 weeks, with the extension of treatment time,gradually increased. Hemoglobin, serum potassium decreased significantly 1 week after treatment and reached the lowest point 2 weeks after treatment, and increased after 3 weeks, with the extension of treatment, they gradually rose. TnI,heart rate, electrocardiogram in group B were significantly higher than group A 1, 2, 3, 4 and 5 weeks after treatment,while hemoglobin was significantly lower than group A.Serum magnesium in group B was significantly higher than group A 1, 2, 3 weeks after treatment, while serum potassium was significantly lower than group A（P〈0.05）.Conclusion Myocardial damage induced by arsenite in treatment of acute promyelocytic leukemia has more evaluation indexes, which increase significantly in patients with myocardial damage, it can be used as an effective index in guiding clinical diagnosis and treatment.