本文關(guān)鍵詞： 調(diào)強放射治療 放射性心臟損傷 心電圖 心肌酶 心肌肌鈣蛋白I 彩色多普勒超聲心動圖 劑量體積直方圖　出處：《河北醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討胸部腫瘤放療后心電圖、心肌酶譜、血清心肌肌鈣蛋白I（cTnI）、心臟功能改變及臨床、物理等因素與急性放射性心臟損傷的相關(guān)性。 方法：2011年11月至2012年12月序貫入組的首程放療胸部腫瘤患者51例，其中肺癌25例（中央型24例，周圍型1例），食管癌26例（胸上段5例，中段13例，下段8例），49例經(jīng)病理證實，2例患者依據(jù)癥狀及影像學(xué)檢查臨床診斷為肺癌。均采用調(diào)強放療方式，食管癌PTV處方劑量50-63Gy（中位劑量60Gy）,肺癌PTV處方劑量46.8-66Gy(中位劑量58Gy),1.8-2.1Gy/次/日，5次/周。所有患者均于放療前、放療結(jié)束及放療后3個月行心電圖、心肌酶譜、血清cTnI及彩色多普勒超聲心動圖檢查，應(yīng)用NCI-CTCAE3.0評價標(biāo)準(zhǔn)對急性放射性心臟損傷進行評價。探討胸部腫瘤患者放療后心電圖、心肌酶譜、血清cTnI、心功能改變及臨床、物理因素（性別、年齡、高血壓病史、化療、KPS評分、TNM分期、心臟Dmax、心臟Dmin、心臟Dmean、心臟D100~D10、心臟V5~V60）與急性射性心臟損傷的相關(guān)性。 結(jié)果：本研究共發(fā)生急性放射性心臟損傷37例，總發(fā)生率為72.55%(37/51)，其中1級放射性心臟損傷34例，2級放射性心臟損傷2例，3級放射性心臟損傷1例，未發(fā)生3級以上放射性心臟損傷者。 1心電圖與急性放射性心臟損傷： 21例患者出現(xiàn)心電圖異常，其中竇性心動過速6例、房性或室性期前收縮6例，ST-T改變4例、左或右束支傳導(dǎo)阻滯2例、左室高電壓2例、竇性心動過緩1例。17例于放療結(jié)束時即出現(xiàn)異常，3個月后復(fù)查，其中8例恢復(fù)正常，仍有9例異常（竇性心動過速3例、房性期前收縮1例，ST-T改變1例、左束支傳導(dǎo)阻滯1例、竇性心動過緩1例、左室高電壓2例），4例于放療后3個月出現(xiàn)心電圖異常（竇性心動過速2例、房性期前收縮2例）。 2心肌酶譜、血清cTnI與急性放射性心臟損傷： 11例患者出現(xiàn)心肌酶譜升高，5例患者出現(xiàn)cTnI升高。放療前、放療結(jié)束、放療后3個月血清AST、CK、CK-MB、LDH、HBDH比較，血清AST、CK水平放療結(jié)束時較放療前降低，而放療后3個月水平較放療前有所升高（P＜0.05）。血清CK-MB水平放療結(jié)束及療后3個月較放療前均降低。血清LDH、HBDH水平于放療結(jié)束及放療后3個月差異無統(tǒng)計學(xué)意義。放療結(jié)束時血清cTnI水平較放療前升高，而放療后3個月血清cTnI水平有所降低（F=3.468,P=0.035）。 3心功能與急性放射性心臟損傷： 26例患者出現(xiàn)左心室收縮功能減低，8例患者出現(xiàn)左室舒張功能減低，3例患者出現(xiàn)心包積液。放射治療前、放療結(jié)束及放療后3個月心功能各項指標(biāo)相比，放療前、放療結(jié)束及放療后3個月左室射血分?jǐn)?shù)、短軸縮短率及E/A值差異有統(tǒng)計學(xué)意義(P均＜0.05)。放療結(jié)束及放療后3個月左室射血分?jǐn)?shù)持續(xù)降低，短軸縮短率及E/A值于放療結(jié)束時降低，放療后3個月有所升高。 4物理、臨床因素與急性放射性心臟損傷： 損傷組與未損傷組患者物理因素差異無統(tǒng)計學(xué)意義（P＞0.05）。損傷組與未損傷組臨床各因素比較均無統(tǒng)計學(xué)意義（P＞0.05）。單因素分析物理因素及臨床因素，未發(fā)現(xiàn)放射性心臟損傷發(fā)生的影響因素。 結(jié)論：急性放射性心臟損傷中心電圖異常較為常見，，主要為竇性心動過速和期前收縮，放射線致心電圖異常部分為可逆性的。血清AST、CK、 cTnI水平于放療后均升高，其中血清cTnI更為敏感。放療結(jié)束后即可出現(xiàn)左室收縮、舒張功能減低。未發(fā)現(xiàn)心臟劑量-體積參數(shù)及患者臨床情況與急性放射性心臟損傷發(fā)生的相關(guān)性。
[Abstract]:Objective: To explore the correlation between electrocardiogram, myocardial enzyme spectrum, serum cardiac troponin I (cTnI), cardiac function changes, clinical and physical factors and acute radiation heart injury after radiotherapy for thoracic tumor.
Methods: 51 patients with primary radiotherapy of thoracic tumor from November 2011 to December 2012 order penetration group cases, including 25 cases of lung cancer (24 cases of central type, 1 cases of peripheral type), 26 cases of esophageal cancer (5 cases, 13 cases of middle upper thoracic segment, 8 cases), 49 cases were confirmed by pathology, 2 cases on the basis of the symptoms and imaging examination in clinical diagnosis of lung cancer. Using intensity-modulated radiotherapy, esophageal cancer PTV 50-63Gy prescription dose (median dose 60Gy), lung cancer PTV 46.8-66Gy prescription dose (median dose 58Gy), 1.8-2.1Gy/ times / day, 5 times a week. All patients before radiotherapy, radiotherapy and after radiotherapy 3 months for ECG, myocardial enzymes, serum cTnI and color Doppler echocardiography. The application of NCI-CTCAE3.0 evaluation criteria to evaluate the acute radiation-induced heart injury. To investigate the electrocardiogram in patients with chest tumor radiotherapy, myocardial enzymes, serum cTnI, heart function and clinical and physical factors (gender, year Age, history of hypertension, chemotherapy, KPS score, TNM staging, cardiac Dmax, cardiac Dmin, cardiac Dmean, cardiac D100~D10, cardiac V5~V60) and acute radiative cardiac injury.
Results: there were 37 cases of acute radiation-induced heart injury. The total incidence rate was 72.55% (37/51), including 1 cases of radiation-induced heart injury, 34 cases, 2 cases of radiation-induced heart injury 2 cases, 3 cases of radiation-induced heart injury 1 cases, and no more than 3 cases of radiation-induced heart injury.
1 electrocardiogram and acute radionuclide injury:
21 patients had ECG abnormalities, including 6 cases of sinus tachycardia, atrial or ventricular contractions in 6 cases, 4 cases of ST-T, 2 cases of left or right bundle branch block, 2 cases of left ventricular high voltage, sinus bradycardia in 1 cases of.17 patients at the end of radiotherapy appears abnormal, 3 months after the review, of which 8 cases returned to normal, there are still 9 cases of abnormal (3 cases of sinus tachycardia, 1 cases of atrial extrasystole, ST-T changes in 1 cases, 1 cases of left bundle branch block sinus bradycardia in 1 cases, 2 cases of left ventricular high voltage) in 4 cases, 3 months after radiotherapy of ECG abnormalities (2 cases of sinus tachycardia, 2 cases of atrial extrasystole).
2 myocardial enzyme spectrum, serum cTnI and acute radionuclide injury:
11 cases of patients with myocardial enzyme, 5 patients had elevated cTnI. Before radiotherapy, radiotherapy, radiotherapy 3 months after serum AST, CK, CK-MB, LDH, HBDH, serum AST, CK levels after radiotherapy decreased compared to that before radiotherapy and after radiotherapy, 3 months before radiotherapy level is rising high (P < 0.05). The level of serum CK-MB after radiotherapy and 3 months after treatment than before radiotherapy were decreased. The serum levels of LDH, there was no significant difference in HBDH Level 3 months after radiotherapy and after radiotherapy. The level of serum cTnI after radiotherapy was higher than before radiotherapy, and serum cTnI levels in 3 months to reduce radiotherapy after (F=3.468, P=0.035).
3 cardiac function and acute radionuclide injury:
26 cases of patients with left ventricular systolic dysfunction, 8 cases of patients with left ventricular diastolic dysfunction, 3 cases of patients with pericardial effusion. Before radiotherapy, radiotherapy and after radiotherapy in 3 months, the index of heart function before radiotherapy, radiotherapy and radiotherapy after 3 months of left ventricular ejection fraction, short axis shortening rate and E/A was statistically significant difference (P < 0.05). The end of radiotherapy and radiotherapy after 3 months of left ventricular ejection fraction decreased, shortening rate and E/A value to the end of radiotherapy decreased 3 months after radiotherapy was increased.
4 physical, clinical factors and acute radionuclide injury:
There was no significant difference in physical factors between the injury group and the non injury group (P > 0.05). There was no significant difference in the clinical factors between the injury group and the non injury group (P > 0.05).
Conclusion: acute central EEG abnormal radioactive heart injury is common, mainly for sinus tachycardia and premature contraction velocity, radiation induced abnormal ECG is reversible. Serum AST, CK, cTnI levels in serum were increased after radiotherapy, which is more sensitive to cTnI. After the end of radiotherapy can appear left ventricular systolic, no correlation of cardiac diastolic function decreased. Dose volume parameters and clinical situation of patients with acute radiation-induced heart injury was found.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R818.74

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