心电图筛查经胸放疗联合化疗对高血压患者心功能异常的研究

Research on cardiac dysfunction of hypertensive patients undergoing thoracic radiation therapy(TRT) combined with chemotherapy by electrocardiographic screening(ECG)

目的:探讨心电图早期评价高血压肿瘤患者接受联合放、化疗后心脏功能改变的临床价值.方法:分析符合WHO/ISH高血压诊断标准的高血压左侧乳腺癌术后患者60例为观察组,无高血压左侧乳腺癌术后患者30例为对照组,血压水平均经正规治疗严格控制,年龄35~70岁.两组均接受心肌酶谱和心电图检查,比较两组心肌酶谱,心电图和超声心动图诊断的差异.结果:化疗前观察组肌酸激酶同工酶-MB(CK-MB)和肌酸激酶(CK)水平与对照组无明显差异(P>0.05),化疗期中后期观察组肌酸激酶同工酶-MB(CK-MB)和肌酸激酶(CK)水平明显升高,升高程度大于对照组(P<0.05);观察组新增异常超声心动图比率(28.3%)显著高于对照组(13.3%)(P<0.05);观察组化疗后新增异常心电图比率(36.7%)显著高于对照组(23.3%)(P<0.05),心电图和超声心动图比较显示超声心动图异常患者多数有心电图异常,其中观察组100%,对照组83.3%.结论:经胸放疗联合化疗明显地导致高血压患者心功能异常,心电图能准确地预测经胸放疗联合化疗患者心功能异常,为后续诊疗提供依据.

Aim： To study the clinical value of electrocardiogram in early evaluation of cardiac function in cancer patients with hypertensive after radiotherapy plus chemotherapy. Methods： According to WHO/ISH hypertension diagnostic criteria,60 cases postoperative patients with left breast cancer diagnosed as hypertension were enrolled as observed group,while 30 cases postoperative patients with left breast cancer diagnosed as no hypertension were enrolled as control group. The age of all patients were between 35 to 70. Blood pressure levels of all patients were strictly controlled by formal treatment.Myocardial enzymes,electrocardiogram（ECG） and ultrasonic cardiogram（UCG） were detected to identified the differences between two groups. Results： There was no significantly difference in CK-MB and CK between the observed group and the control group（P〉0. 05）. The levels of CK-MB and CK in themiddle and late stages of chemotherapy in observed group were significantly higher than those in the control group（P〈0. 05）. Echocardiography showed that the rate of abnormal UCG in the observed group（28. 3%） was significantly higher than that in the control group（13. 3%）（P〈0. 05）. The rate of abnormal ECG（36. 7%） was significantly higher than that of the control group（23. 3%）（P〈0. 05）.It showed that,ECG results comparing with the UCG,abnormal ECG was found among most patients with abnormal UCG,including 100% of the observed group and 83. 3% of the controlgroup. Conclusion：Chest radiotherapy combined with chemotherapy obviously results in cardiac dysfunction among hypertensive patients. ECG as an early screening method could predicte cardiac dysfunction precisely and in consequence repeatedly and timely ECG detecting contributes great clinical significance to patients after chest radiotherapy combined with chemotherapy.