CAJ | 학술논문

目的：探讨QT间期离散度和超声心动图预测阿霉素引起的早期心肌损伤的应用价值。 　　方法：收集2012-01至2013-12期间在我院确诊并有明确病理分型的44例乳腺癌患者，且均采用含蒽环类药物的方案化疗，表阿霉素应用剂量为75 mg/m2，进行1~5个化疗周期，随着化疗进程，体内阿霉素累积剂量不同，动态监测心电图QT间期离散度及心脏超声心动图变化并进行分析。 　　结果：每个疗程化疗后QT间期离散度分别为40.00（40.00，50.00）ms、42.50（30.75，60.00）ms、45.00（35.00，50.00）ms、40.00（35.00，55.00）ms、45.00（30.00，70.00）ms，较应用表阿霉素前基线水平32.50（25.00，40.00） ms均明显延长（P均<0.05），差异有统计学意义。每个疗程化疗后左心室舒张末期内径较应用表阿霉素前基线水平呈轻度增大趋势、左心室射血分数和左心室缩短分数呈轻度下降趋势，但差异均无统计学意义（P均>0.05）。 　　结论：心电图QT间期离散度用于评价阿霉素心肌病较心脏超声心动图的左心室舒张末期内径、左心室射血分数和左心室缩短分数更为敏感。通过监测心电图QT间期离散度变化，从而能及早在心肌损伤亚临床阶段发现其心脏毒性的发生与进展。
목적：탐토QT간기리산도화초성심동도예측아매소인기적조기심기손상적응용개치。 　　방법：수집2012-01지2013-12기간재아원학진병유명학병리분형적44례유선암환자，차균채용함은배류약물적방안화료，표아매소응용제량위75 mg/m2，진행1~5개화료주기，수착화료진정，체내아매소루적제량불동，동태감측심전도QT간기리산도급심장초성심동도변화병진행분석。 　　결과：매개료정화료후QT간기리산도분별위40.00（40.00，50.00）ms、42.50（30.75，60.00）ms、45.00（35.00，50.00）ms、40.00（35.00，55.00）ms、45.00（30.00，70.00）ms，교응용표아매소전기선수평32.50（25.00，40.00） ms균명현연장（P균<0.05），차이유통계학의의。매개료정화료후좌심실서장말기내경교응용표아매소전기선수평정경도증대추세、좌심실사혈분수화좌심실축단분수정경도하강추세，단차이균무통계학의의（P균>0.05）。 　　결론：심전도QT간기리산도용우평개아매소심기병교심장초성심동도적좌심실서장말기내경、좌심실사혈분수화좌심실축단분수경위민감。통과감측심전도QT간기리산도변화，종이능급조재심기손상아림상계단발현기심장독성적발생여진전。
Objective: To explore the early predictive value and sensitivity of QT interval dispersion and echocardiography in patients with epirubicin cardiomyopathy. Methods: A total of 44 patients with confirmed diagnosis of breast cancer treated in our hospital from 2012-01 to 2013-12 were studied. All patients received chemotherapy with anthracycline for 1-5 cycles, and the dose of epidoxorubicina was 75 mg/m2. With different dose of epirubicin accumulated by chemotherapy in vivo, the changes of QT interval dispersion and echocardiography were examined and analyzed to study the cardiac injury in those patients. Results: Compared with the baseline QT interval dispersion at 32.5 (25.00, 40.00) ms, the QT interval dispersion after each chemotherapy cycle were at 40.00 (40.00, 50.00) ms, 42.50 (30.75, 60.00) ms, 45.00 (35.00, 50.00 ) ms, 40.00 (35.00, 55.00) ms and 45.00 (30.00, 70.00) ms respectively, they were all longer than the baseline, P<0.05. Echocardiography indicated that after each chemotherapy cycle, left ventricular end-diastolic diameter (LVEDD) was slightly increased, while LVEF and LVFS were slightly decreased, P>0.05. Conclusion: QT interval dispersion of ECG is more sensitive for evaluating the patients with epirubicin cardiomyopathy than the indexes of LVEDD, LVEF and LVFS by echocardiography. ECG monitoring of QT interval dispersion in chemotherapy patients may ifnd the early toxic cardiac injury at subclinical stage in relevant patients.