心率减速力与表阿霉素所致心肌损伤的相关性分析

Relative analysis of between deceleration capacity of heart rate and epirubicin-induced cardiotoxicity

目的探讨心率减速力(deceleartion capacity of heart rate,DC)对血液系统肿瘤患者中表阿霉素所致心肌损伤的预测价值。方法纳入40例接受含表阿霉素方案治疗的血液系统肿瘤患者(非何杰金淋巴瘤26例,多发性骨髓瘤14例),所有患者均于化疗前、化疗2周期、4周期与6周期后行动态心电图与超声心动图检查,分析DC值与高血压病史、化疗周期数及左室射血分数(LVEF)的相关性。结果 1在有高血压组,化疗前、化疗6周期的DC值异常率(DC≤4.5 ms)明显高于无高血压组(P<0.05);无论有无高血压情况,化疗6周期后患者DC值均明显低于化疗前(P<0.05);2与化疗前相比,化疗4、6周期后的DC值异常率明显增高(P<0.05);化疗2、6周期后的DC值异常率有明显差异(P<0.05);3化疗6周期后,有高血压组的DC值明显低于无高血压病(P<0.05),但LVEF值却无明显差异(P>0.05);4在有或无高血压病组,化疗6周期后两组的DC与LVEF之间均呈正相关(r分别为0.81与0.84,P<0.05)。结论在血液系统肿瘤中,DC值下降可作为表阿霉素蓄积性心脏毒性的指标,且较LVEF更早提示心肌损伤,高血压病史可作为表阿霉素心脏毒性的加重因素。

Objective To explore the prediction role of deceleration capacity of heart rate （ DC） in patients with hematologi-cal malignancies treated with epirubicin-based regimen. Methods 40 consecutive patients received the treatment of the epirubicin-based regimen, i.e. 26 with non-Hodgkin leukemia, 14 with multiple myeloma. The dynamic electrocardiogram and ultrasonic cardio-gram were examined in all patients before the initial chemotherapy and after the 2^th , 4^th , and 6^th chemotherapy. The DC was designed as abnormal when DC≤4.5 ms. The correlations of DC with the history of hypertension, the chemotherapy cycles and left ventricular ejec-tion fraction （ LVEF） were analysed. Results ①The abnormal rate of DC in patients with hypertension was higher than that in patients without hypertension both before and after 6 cycles of chemotherapy （P〈0.05）. At the 6^th chemotherapy, the patients with or without hypertension possessed higher rate of abnormal DC when compared with patients without chemotherapy （ P〈0.05） . ②The abnormal rate of DC was markedly higher in patients accepting 4, 6 cycles of chemotherapy in comparison with the baseline（P〈0.05）. Significant difference of the DC existed in patients between the 2^nd and 6^th chemotherapy（ P〈0.05） . ③When treated with 6 cycles of chemothera-py, the patients with hypertension exhibited lower DC in comparison with patients without hypertension（ P〈0.05） . No significant differ-ence of LVEF was observed between the two groups（P〉0.05）. ④The DC was positively associated with LVEF in the group with or without hypertension when treated with 6 cycles of chemotherapy（ r=0.81,0.84;P〈0.05） . Conclusion In patients with hematological malignancies, the decrease of DC may be regarded as the prognostic index of accumulative cardiotxicity from epirubicin and indicate the earlier myocardial damage when compared with LVEF. The history of hypertension may increase the cardiotoxicity when patients re-ceived epirubicin treatment.