基础心功能状况与急性放射性心脏损伤的相关性研究

Correlation between basic cardiac function and acute radiation-induced heart injury

目的探讨胸部放疗基础心功能状况对急性放射性心脏损伤的影响，评价急性期内患者心功能的变化。方法分析109例胸部肿瘤患者放疗后基础心功能状况对急性放射性心脏损伤的影响，并观察放疗前及急性观察期内心功能的变化。结果全组患者急性放射性心脏损伤发生率为79．8％，患者临床因素及基础心功能各项指标与急性放射性心脏损伤发生均无明显相关（P〉0．05）。放射治疗后急性期内出现左室收缩功能减低24例，舒张功能减低15例；瓣膜病变24例，全部为二尖瓣和（或）主动脉瓣改变，其中反流（轻、中度反流）23例、狭窄（轻度）1例，未见三尖瓣和（或）肺动脉瓣反流与狭窄。左房前后径、主动脉流速、E／A值在放疗前、放疗结束、自放疗开始3个月差异有统计学意义（F=8．552、0．017、0．003，P〈0．05）。左房前后径、主动脉流速、E／A值放疗结束较放疗前分别下降了9．19％、7．56％、17．5％，自放疗开始3个月较放疗结束分别恢复7．05％、4．14％、7．58％，其中E／A下降和恢复变化幅度最大。结论临床因素及基础心功能状况与急性放射性心脏损伤发生无明显相关。放疗导致的瓣膜病变以二尖瓣和（或）主动脉瓣轻、中度反流多见，并可引起左室收缩和舒张功能改变。左房前后径、E／A值放疗后首先降低，随着时间延长逐渐改善，但急性期内未能恢复到正常水平。急性观察期内放疗对心脏舒张功能的影响较收缩功能明显。

Objective To investigate the correlation between basic cardiac function and acute radiation-induced heart injury, and evaluate the changes of cardiac function of patients with acute stage radiation injury. Methods A total of 109 patients with thoracic tumor underwent radiation therapy. Changes of basic cardiac function before, after, and within the first 3 months of radiation were recorded respectively. Effects of radiation on cardiac function and incidence of acute radiation-induced heart injury were analyzed. Results The overall incidence of acute radiation-induced heart injury was 79.8%, with no significant correlation with basic cardiac function （P 〉 0. 05）. In acute stage post radiation injury, there were 24 cases of decreased left ventricular diastolic function and 15 cases of decreased systolic function were found respectively. All 24 cases of cardiac valve injury presented with mitral valve and （or） aortic valve damage, including 23 reflux （ mild and moderate degree） and 1 stenosis （ mild degree） , whereas no tricuspid and （or） pulmonary valves injuries were observed. Fore-and-afl pathways of left atria, flow velocities of aorta, and E/A values were all significantly different either after or within the first 3 months of radiation（F = 8. 552,0. 017,0. 003, P 〈 0. 05 ）. Compared with pre-radiation values, the above three parameters decreased by 9. 19%, 7.56% and 17.5% respectively post-radiation, and recovered by 7.05% ,4. 14% and 7.58% at the time within the first 3 months. Moreover, E/A values showed the greatest degree of change. Conclusions Neither clinical features nor basic cardiac function is associated with acute RIHD. Radiation induce mild reflux of bicuspid valves and aortic valves are more common in patients that receive thoracic radiation. Fore-and-aft pathways of left atria, flow velocities of aorta, and E/A values first reduce at the end of the radiation treatment and then gradually recovered, but are unable to return to basic levels in the acute stage. Acute radiative effects on cardiac diastolic function are more significant than those on systolic function.