本文關(guān)鍵詞： 蒽環(huán) QTc 心電圖異常 急性心臟毒性 危險(xiǎn)因素　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析253例乳腺癌患者使用蒽環(huán)類藥物治療后出現(xiàn)心電圖異常的臨床特點(diǎn),探討使用蒽環(huán)類藥物治療的乳腺癌患者發(fā)生急性心臟毒性的危險(xiǎn)因素。材料與方法:收集253例組織學(xué)或細(xì)胞學(xué)確診為乳腺癌、使用過(guò)3—8周期蒽環(huán)藥物化療、化療前心電圖無(wú)異常的患者,回顧性分析蒽環(huán)藥物化療前后的心電圖變化,將心電圖發(fā)生異常改變作為蒽環(huán)治療急性心臟毒性的診斷指標(biāo)�？偨Y(jié)各類心電圖異常變化在乳腺癌蒽環(huán)化療患者中的發(fā)生率及校正后QT間期(QTc)隨化療周期數(shù)的變化特點(diǎn)。對(duì)比患者的年齡、身體質(zhì)量指數(shù)(BMI)、腫瘤TNM分期、既往是否存在高血壓及糖尿病史、是否聯(lián)合放療、蒽環(huán)類藥物的種類及累積劑量等因素在心電圖異常組和無(wú)心電圖異常組患者間的差別是否有統(tǒng)計(jì)學(xué)意義,以及蒽環(huán)類藥物出現(xiàn)心電圖異常與上述各因素之間是否存在相關(guān)性。并通過(guò)回歸分析總結(jié)乳腺癌患者應(yīng)用蒽環(huán)類藥物治療后出現(xiàn)急性心臟毒性的危險(xiǎn)因素。結(jié)果:253例患者中出現(xiàn)心電圖異常變化者共92例,發(fā)生率為36.36%,其中電生理和節(jié)律異常改變78例,發(fā)生率30.83%,發(fā)生率由高到低依次為:T波改變、ST改變、竇性心動(dòng)過(guò)速、竇性心動(dòng)過(guò)緩、房性期前收縮、室性期前收縮、異常Q波、房室傳導(dǎo)阻滯、右束支傳導(dǎo)阻滯、交界性早搏;QTc延長(zhǎng)31例,發(fā)生率12.25%。QTc1—4周期內(nèi)延長(zhǎng)幅度較大且有統(tǒng)計(jì)學(xué)意義(p均0.05),5—8周期有所延長(zhǎng)但差異無(wú)統(tǒng)計(jì)學(xué)意義(p均0.05)。蒽環(huán)類藥物治療后發(fā)生心電圖異常在蒽環(huán)累積劑量及年齡之間的差別有統(tǒng)計(jì)學(xué)意義(p均0.05),進(jìn)一步分析得出患者年齡為急性心臟毒性的獨(dú)立危險(xiǎn)因素(p0.05)。而其他因素,如體重指數(shù)BMI、腫瘤TNM分期、高血壓病史、糖尿病病史、聯(lián)合同步放療、蒽環(huán)藥物種類與心電圖異常改變的關(guān)聯(lián)無(wú)統(tǒng)計(jì)學(xué)意義(p均0.05)。結(jié)論:蒽環(huán)類藥物治療期間急性心臟毒性事件發(fā)生率較高,主要表現(xiàn)為電生理和節(jié)律異常改變、QTc延長(zhǎng)。QTc隨蒽環(huán)化療周期的增加呈增長(zhǎng)趨勢(shì)�；颊吣挲g及蒽環(huán)藥物累積劑量與急性心臟毒性具有相關(guān)性,其中患者年齡是蒽環(huán)藥物急性心臟毒性的獨(dú)立危險(xiǎn)因素。因此在治療過(guò)程中應(yīng)加強(qiáng)對(duì)老年患者的心臟監(jiān)護(hù),并控制蒽環(huán)藥物的累積劑量在安全范圍內(nèi)。
[Abstract]:Objective: to analyze the clinical features of abnormal electrocardiogram (ECG) in 253 patients with breast cancer treated with anthracycline. To investigate the risk factors of acute cardiac toxicity in breast cancer patients treated with anthracycline drugs. Materials and methods: 253 cases of breast cancer diagnosed by histology or cytology were collected and treated with anthracycline chemotherapy for 3-8 cycles. The changes of ECG before and after anthracycline chemotherapy in patients with no abnormal ECG before and after chemotherapy were analyzed retrospectively. The abnormal changes of electrocardiogram (ECG) were regarded as diagnostic indexes of acute cardiac toxicity treated with anthracycline. The incidence of abnormal changes of ECG in patients with anthracycline chemotherapy and the change of QT interval QTc with the number of chemotherapy cycles were summarized. Compare the age of the patient, Body mass index (BMI), tumor TNM stage, history of hypertension and diabetes, combined radiotherapy. Whether there were significant differences in the types and cumulative doses of anthracyclines between patients with abnormal electrocardiogram and those without abnormal ECG, The risk factors of acute cardiac toxicity in breast cancer patients treated with anthracycline drugs were summarized by regression analysis. Of 253 patients, 92 had abnormal changes in electrocardiogram. The incidence of abnormal electrophysiological and rhythmic changes was 36.36. The incidence of abnormal electrophysiology and rhythm was 30.83.The order of incidence from high to low was St change of T wave, sinus tachycardia, sinus bradycardia, atrial premature contraction, ventricular premature contraction, abnormal Q wave. Atrioventricular block, right bundle branch block, QTc prolongation of borderline premature beat in 31 cases, The incidence rate was 12.25%. QTc1-4 cycle was prolonged by a large extent and the 5-8 cycles were prolonged with statistical significance. The difference was not statistically significant (P > 0.05). The difference between the cumulative dose and age of anthracycline after treatment with anthracycline. Further analysis showed that the age of patients was an independent risk factor of acute cardiac toxicity. For example, body mass index (BMI), tumor TNM stage, hypertension history, diabetes history, combined radiotherapy, There was no significant correlation between the types of anthracycline drugs and the abnormal changes of ECG. Conclusion: the incidence of acute cardiac toxicity events during the treatment of anthracycline drugs is higher. The main manifestations were the prolongation of QTc in electrophysiology and rhythm. QTc increased with the increase of anthracycline chemotherapy cycle. The age of patients and the cumulative dose of anthracycline drugs were correlated with acute cardiac toxicity. Patient age is an independent risk factor for acute cardiac toxicity of anthracyclines. Therefore, cardiac monitoring should be strengthened in elderly patients and the cumulative dose of anthracycline should be controlled within a safe range.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9

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本文編號(hào)：1532152