Q-T间期离散度联合肌钙蛋白Ⅰ检测早期诊断乳腺癌蒽环类化疗所致心脏毒性的价值

The value of Q-T interval dispersion combined with troponinⅠin the early diagnosis of cardiac toxicity induced by anthracycline c-hemotherapy in breast cancer

目的:探讨Q-T间期离散度(QTd)联合肌钙蛋白I(cTnI)在蒽环类化疗药所致心脏毒性早期检测中的应用价值。方法:回顾性分析我医院2019年01月至2020年06月用蒽环类药物完成化疗的97例乳腺癌患者的临床资料。以左心射血分数(LVEF)下降幅度及充血性心衰症状为参考标准将纳入患者分为观察组(心脏毒性组)与对照组(非心脏毒性组),统计其QTd、cTnI水平,用SPSS 25.0分析软件进行数据处理。结果:入组的97例患者中18人发生心脏毒性,发生率18.6%。化疗前对照组与观察组QTd、cTnI基线水平无明显统计学差异(P>0.05);各化疗周期后QTd、cTnI水平均较基线水平明显升高(P<0.05);相同化疗周期观察组QTd、cTnI水平明显高于对照组(P<0.05)。QTd、cTnI的ROC曲线下面积(AUC)分别为0.877、0.871,敏感性分别为85.4%、82.6%,特异性分别为96.5%、93.4%,联合应用时AUC为0.876,敏感性与特异性分别为84.0%、97.3%。结论:QTd、cTnI检测均可作为无创性评估蒽环类化疗药所致心脏毒性发生的前瞻性方法之一;QTd、cTnI联合应用具有更高的诊断价值。

Objective:To investigate the value of Q-T interval dispersion(QTd)combined with troponin I(cTnI)in the early detection of cardiotoxicity induced by anthracyclines.Methods:The clinical data of 97 patients with breast cancer who received anthracycline chemotherapy in our hospital from January 2019 to June 2020 were retrospectively analyzed.The patients were divided into observation group(cardiotoxicity group)and control group(non-cardiotoxicity group)according to the reduced range of left ventricular ejection fraction(LVEF)and symptoms of congestive heart failure as the reference criteria.The levels of QTd and cTnI were statistically analyzed,and the data were processed by SPSS 25.0 analysis software.Results:Cardiotoxicity occurred in 18 of the 97 patients enrolled,with an incidence of 18.6%.Before chemotherapy,there were no statistically significant differences in baseline QTd and cTnI levels between the control group and the observation group(P>0.05).QTd and cTnI levels after each chemotherapy cycle were significantly higher than the baseline level(P<0.05).The levels of QTd and cTnI in observation group were significantly higher than those in control group during the same chemotherapy cycle(P<0.05).The area under ROC curve(AUC)of QTd and cTnI were 0.877 and 0.871,respectively.The sensitivity and specificity were 85.4%,82.6%and 96.5%,93.4%,respectively.The AUC of combined application was 0.876,the sensitivity and specificity were 84.0%and 97.3%,respectively.Conclusion:Both QTd and cTnI detection can be used as one of the prospective methods for noninvasive evaluation of cardiotoxicity induced by anthracycline.The combined application of QTd and cTnI has higher diagnostic value.