曲妥珠单抗对乳腺癌患者早期心脏电重构的影响

Effect of trastuzumab on early cardiac electrical remodeling in patients with breast cancer

目的 研究人类表皮生长因子受体2(HER2)阳性乳腺癌患者使用曲妥珠单抗靶向辅助治疗中早期心脏电损害的临床预测指标。方法 对我院2017年5月~2020年9月连续170例接受曲妥珠单抗药物治疗的乳腺癌患者的临床资料进行回顾性分析。通过评估药物使用前后心电图参数变化预测早期心脏电损害,包括SV1、RV5、P波电轴、R波电轴、PR间期、QT间期、QTc间期、QRS间期、T波峰末间期(Tp-Te)、Tp-Te/QTc。通过心脏彩超各项参数评估心脏结构功能变化。结果 所有患者治疗前后血压、心脏彩超、心电图临床判定均正常。治疗前后血压、血清钾水平、血清钙水平、左室射血分数(LVEF)、左室短轴缩短分数(LVFS)、左室舒张末期内径(LVEDd)、左房内径(LAD)、室间隔厚度(IVS)、左室后壁厚度(LVPWT)、右室内径(RVD)、右房内径(RAD)、SV1、RV5/SV1、T波电轴、P波电轴均无显著性差异(P>0.05);与治疗前相比,治疗后RV5振幅减低、R波电轴偏移、PR间期延长、QT间期缩短、QRS间期延长、V2导联T波峰末间期(Tp-Te)延长、V2Tp-Te/QTc比值增大,差异有统计学意义(P<0.05),但校正的QTc间期在治疗前后无显著性差异(P>0.05)。结论 在接受曲妥珠单抗治疗的乳腺癌患者中,密切监测Tp-Te间期、Tp-Te/QTc比值、PR间期、QRS间期、R波振幅变化可预测早期心脏电损害。

Objective To investigate the clinical predictors of early cardiac electrical damage in patients with human epidermal growth factor receptor 2(HER2) positive breast cancer treated with trastuzumab targeted adjuvant therapy.Methods A total of 170 patients with breast cancer treated with trastuzumab in our hospital from May 2017 to Sep 2020 were retrospectively reviewed. Early cardiac electrical damage was predicted by evaluating the changes of ECG parameters before and after treatment, including SV1, RV5, P-wave axis, R-wave axis, PR interval, QT interval, QTc interval, QRS interval, T-peak to T-end interval(Tp-Te), Tp-Te/QTc. The changes of cardiac structure and function were evaluated by various parameters of echocardiography(LVEF, LVFS, LVEDd, LAD, RVD, RAD). Results Blood pressure,echocardiography and ECG were normal before and after treatment in all patients. Under the above conditions, blood pressure, serum potassium level, serum calcium level, left ventricular ejection fraction(LVEF), left ventricular fractional shortening LVFS, left ventricular end diastolic diameter(LVEDd), left atrial diameter(LAD), interventricular septum thickness(IVS), left ventricular posterior wall thickness(LVPWT), right ventricular diameter(RVD), right atrial diameter(RAD), SV1, RV5/SV1, T-wave axis, P-wave axis were no statistical differences before and after treatment(P>0.05).However, there were significant differences in ECG after treatment as follows: RV5 amplitude was decreased, R wave axis was changed, PR interval was prolonged, QT interval was shortened, QRS interval was prolonged, Tp-Te of V2 lead was prolonged and V2Tp-Te/QTc ratio was increased(P>0.05). But there was no significant difference in correcting QTc interval(P>0.05). Conclusion In patients with breast cancer receiving trastuzumab therapy, it indicated that to predict early cardiac electrical damage, Tp-Te interval, Tp-Te/QTc ratio, PR interval, the change of R wave amplitude and QRS interval should be closely monitored during the treatment.