乳腺放疗与乳腺癌幸存者发生冠心病的临床特征分析

Analysis of clinical characteristics of breast cancer survivors who received breast radiotherapy and diagnosed with coronary heart disease

目的:比较女性乳腺癌幸存者与普通女性初次诊断冠心病的临床特点。方法:回顾性选取2013年1月至2019年12月徐州医科大学附属医院心内科通过冠状动脉(冠脉)造影诊断为初发冠心病的80例女性乳腺癌幸存者为乳腺癌冠心病组,选取2019年1月至12月诊断为初发冠心病的313例女性非乳腺癌患者为非乳腺癌冠心病组,比较2组的危险因素、冠脉造影结果、Gensini评分等。结果:乳腺癌冠心病组有放疗史的左前降支中远端、右冠脉近端损伤人数所占比例和整组Gensini评分均明显高于非乳腺癌冠心病组,差异均有统计学意义(P<0.05)。Logistic回归分析发现,2型糖尿病(OR=4.245,95%CI 1.087~16.576)和放疗史(OR=2.870,95%CI 1.027~8.021)为乳腺癌冠心病组冠脉高Gensini评分的危险因素。结论:女性乳腺癌幸存者发生冠心病的严重程度比普通女性人群更高,且有左乳放疗史的患者左前降支中远端和有右乳放疗史的患者右冠脉近端更容易出现损伤。在女性乳腺癌幸存者中初发冠心病的人群中,2型糖尿病患者及有乳腺放疗史的患者更容易出现严重的冠脉狭窄。

Objective:To compare the clinical characteristics of female breast cancer survivors compared with ordinary women at the first diagnosis of coronary heart disease.Methods:Totally,80 female breast cancer survivors diagnosed by coronary angiography at the Department of Cardiology,Affiliated Hospital of Xuzhou Medical University from January 2013 to December 2019 were included in the breast cancer and coronary heart disease group,and 313 female non-breast cancer patients diagnosed with coronary heart disease by coronary angiography from January to December 2019 were included in the non-breast cancer and coronary heart disease group.The risk factors,coronary angiography results,and Gensini scores of each group were retrospectively analyzed.Results:The proportion of the middle and distal left anterior descending artery and the proximal right coronary artery in the breast cancer coronary heart disease group with a history of radiotherapy and Gensini score was significantly higher than that in the non-breast cancer coronary heart disease group,and the differences were statistically significant(P<0.05).In patients with breast cancer and coronary heart disease,logistic regression analysis showed that type 2 diabetes(OR=4.245,95%CI 1.087-16.576)and radiotherapy history(OR=2.870,95%CI 1.027-8.021)were the risk factors for high Gensini score in this group.Conclusions:The severity of coronary heart disease in female breast cancer survivors was higher than that of the general female population,in addition,patients with a history of radiotherapy on the left side of the breast were more prone to the damage in the middle and distal ends of the left anterior descending branch,Patients with a history of radiotherapy to the right breast are more prone to the damage in the proximal right coronary artery.Among female breast cancer survivors who have newly developed coronary heart disease,patients with type 2 diabetes and patients with a history of breast radiation therapy were also more likely to have severe coronary artery stenosis.