鼻咽癌患者放射治疗后动态心电图及QT离散度和心率变异性改变的探讨  

Changes of ambulatory electrocardiography,QT dispersion,and heart rate variability in nasopharyngeal carcinoma patients after radiotherapy

作　　者：张琴[1] 张雅莉[1] 何宁[2] 陆锦龙[2] 田晓芬[1] 陈晓婕[1] 吴洁[1] 李玲[1] 秦国伟[1] 

机构地区：[1]广西壮族自治区人民医院心电诊断科,广西南宁530021 [2]广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科,广西530021

出　　处：《江苏实用心电学杂志》2014年第4期236-240,244,共6页Journal of Practical Electrocardiology JS

基　　金：广西卫生厅重点课题(桂卫重2011117);广西卫生厅自筹科研课题(Z2011428);广西自然科学基金资助项目(桂科自0728085)

摘　　要：目的：探讨鼻咽癌患者放射治疗后动态心电图、QT离散度和心率变异性（HRV ）的变化情况。方法对40例鼻咽癌患者治疗前及接受3个阶段不同放射剂量（分别为15～25 Gy、35～45 Gy和55～65 Gy）的放射治疗后（每一个治疗阶段均行动态心电图监测），观察放射治疗致心电图及QT离散度（QTd）、校正后QT离散度（QTcd）和HRV时域指标及频域指标改变的情况。结果鼻咽癌患者放疗前和3个阶段放射治疗后动态心电图各项指标比较：（1）室上性心律失常、室性心律失常和ST-T改变的发生率比较，差异均无统计学意义（P＞0．05）；（2）QTd、QTcd指标比较，差异均无统计学意义（P＞0．05）；（3）HRV分析比较，①时域指标SDNN、rMSSD、pNN50差异均无统计学意义（P＞0．05）；②频域指标TP、LF、HF、LF/HF差异均无统计学意义（P＞0．05）；两两比较后，VLF在3个阶段放射治疗后显著低于放疗前，差异有统计学意义（P＜0．05）。结论（1）室性心律失常和ST-T改变的发生率的变化趋势相似，即放射剂量为15～25 Gy时呈上升趋势、35～45 Gy时呈下降趋势、55～65 Gy时呈明显上升趋势；（2）QTd、QTcd指标在放射剂量为15～25 Gy时呈下降趋势、35～45 Gy时呈上升趋势、55～65 Gy时恢复到治疗前水平；（3）HRV指标中，随着放射剂量的增加，VLF的降低更加显著，提示鼻咽癌患者放疗后影响了体温调节、肾素血管紧张素系统及体液因子等因素的长期调节，引起交感神经活动增强，影响交感-迷走神经之间的均衡性，从而影响自主神经调节，导致心电图异常。Objective To investigate the changes of ambulatory electrocardiography （AECG）, QT dispersion（QTd）,and heart rate variability（HRV）in patients with nasopharyngeal carcinoma （NPC）after radiotherapy.Methods Before and after 3 stages of radiotherapy with different doses （15 -25 Gy,35 -45 Gy,and 55 -65 Gy,respectively）,40 cases with NPC underwent AECG monitoring and were observed the changes of AECG,QTd,corrected QT dispersion（QTcd）,and HRV indices of time domain and frequency domain caused by radiotherapy.Results By comparing each index of AECG before and after 3 stages of radiotherapy in NPC patients,we found that：（i） there was no statistically significant difference in the incidences of supraventricular arrhythmia,ven-tricular arrhythmia,and ST-T changes（P〉0.05 ）;between QTd and QTcd,there was no statisti-cally significant difference（P〉0.05）;in the HRV analysis,there was no statistically significant difference either in time domain indices of SDNN,rMSSD,and pNN50 or frequency domain indices of TP,LF,HF and LF/HF（P〉0.05）.Paired-comparison implied that VLF value after the 3 stages of radiotherapy was significantly lower than that before the treatment,and the difference was statisti-cally significant（P〈0.05）.Conclusion （i）The trend of the incidence ventricular arrhythmia was similar to that of ST-T changes,which showed an uptrend at a radiation dose of 15 -25 Gy,a downtrend at a radiation dose of 35 -45 Gy,and a strong uptrend at a radiation dose of 55 -65 Gy. （ii）The indices of QTd and QTcd exhibited a downtrend at a radiation dose of 15 -25 Gy,an up-trend at a radiation dose of 35 -45 Gy,and recovered to pretherapeutic level at a radiation dose of 55 -65 Gy.（iii）Among the HRV indices,the higher the radiation dose was,the more significantly VLF decreased.It hints that radiotherapy on NPC patients affects long-term regulating of body tem-perature,renin-angiotensin system and humoral factors,enhances sympathetic nerve activity,influ-ences sympathetic nerv

关 键 词：鼻咽癌 放射治疗 动态心电图 QT离散度 心率变异性 

分 类 号：R739.6[医药卫生—肿瘤] R540.41[医药卫生—临床医学]