化疗对淋巴瘤患者心电活动的影响及危险因素分析

Effect of chemotherapy on cardiac electrical activity in patients with lymphoma and its risk factors

目的分析化疗对淋巴瘤患者心率变异性(HRV)时域指标及心脏电生理活动的影响。方法选取2020年9月至2021年12月在该院确诊为初治淋巴瘤并接受化疗的76例患者作为淋巴瘤组,另选取年龄、性别匹配的76例健康者作为对照组。观察化疗前后两组HRV时域指标,包括正常窦性RR间期的总体标准差(SDNN)、每5分钟窦性RR间期均值标准差(SDANN)、正常连续窦性RR间期差值均方根(rMSSD)、相邻RR间期差值>50 ms百分比(pNN50),淋巴瘤组化疗前后心肌缺血、房室传导阻滞、窦性心动过缓、快速性心律失常等心血管不良事件发生情况并进行比较分析。观察淋巴瘤患者化疗前后性别、体重指数、24 h平均心率、淋巴瘤疾病分期、危险度分层、国际预后指数(IPI)、美国东部肿瘤合作组表现状态(ECOG-PS)评分及Ki67增殖指数等指标,采用单因素及多因素logistic回归模型分析HRV降低的影响因素。结果化疗前淋巴瘤组SDNN、SDANN、pNN50均明显低于对照组(P<0.05),化疗后淋巴瘤组SDNN、SDANN、rMSSD、pNN50均较化疗前明显降低(P<0.05);淋巴瘤组化疗后心肌缺血、房室传导阻滞、快速性心律失常发生率均较化疗前明显升高(P<0.05)。单因素分析结果显示:淋巴瘤疾病分期、危险度分层、Ki67增殖指数、IPI评分和ECOG-PS评分均是淋巴瘤患者化疗前基线HRV降低及化疗后HRV降低的影响因素(P<0.05);多因素分析结果表明:高ECOG-PS评分[OR=2.46,95%CI(1.44~4.21),P=0.001]是淋巴瘤患者基线HRV降低的独立危险因素,高Ki67增殖指数[OR=1.12,95%CI(1.05~2.20),P<0.001]和高ECOG-PS评分[OR=3.35,95%CI(1.68~6.69),P=0.001]是淋巴瘤患者化疗后HRV降低的独立危险因素。结论淋巴瘤患者与健康人群相比存在一定程度的心脏自主神经功能障碍且在化疗后呈现加重,同时心血管不良事件风险在化疗后明显升高。

Objective To analyze the effects of chemotherapy on time-domain indexes of heart rate variability(HRV)and cardiac electrophysiological activity in patients with lymphoma.Methods From September 2020 to December 2021,a total of 76 patients with newly diagnosed lymphoma and underwent chemotherapy were selected as the lymphoma group,and 76 healthy individuals matched in age and gender were selected as the control group.The time-domain indexes for HRV in the two groups including the standard deviation of 24 h normal RR interval(SDNN),the standard deviation of average RR interval every five minutes(SDANN),root-mean square differences of successive RR intervals(rMSSD)and percentage of adjacent RR intervals>50 ms(pNN50)were observed before and after chemotherapy,and the incidence of cardiovascular adverse events such as myocardial ischemia,atrioventricular block,sinus bradycardia,and tachyarrhythmia was compared in the lymphoma group before and after chemotherapy.The gender,body mass index,24-hour average heart rate,lymphoma disease stage,risk stratification,international prognostic index(IPI),Eastern Cooperative Oncology Group performance status(ECOG-PS)score and Ki67 proliferation index in lymphoma patients were observed before and after chemotherapy,and the influencing factors of HRV reduction were analyzed by univariate and multivariate logistic regression models.Results SDNN,SDANN,and pNN50 in the lymphoma group were significantly lower than those in the control group before chemotherapy(P<0.05).SDNN,SDANN,rMSSD,and pNN50 in the lymphoma group after chemotherapy were significantly lower than those before chemotherapy(P<0.05).The incidence rates of myocardial ischemia,atrioventricular block and tachyarrhythmia in the lymphoma group after chemotherapy was significantly higher than those before chemotherapy(P<0.05).Univariate analysis showed that the stages of lymphoma,risk stratification,Ki67 proliferation index,IPI score and ECOG-PS score were all factors influencing the reduction of HRV before and after chemotherapy in lymphoma patients(P<0.05).Multivariate analysis suggested that high ECOG-PS score[OR=2.46,95%CI(1.44-4.21),P=0.001]was an independent risk factor for HRV reduction before chemotherapy;while high Ki67 proliferation index[OR=1.12,95%CI(1.05-2.20),P<0.001]and high ECOG-PS score[OR=3.35,95%CI(1.68-6.69),P=0.001]were independent risk factors for HRV reduction after chemotherapy in patients with lymphoma.Conclusion Lymphoma patients have a certain degree of cardiac autonomic dysfunction as compared with healthy individuals,which tends to worsen after chemotherapy,and the risk of adverse cardiovascular events is significantly increased after chemotherapy.