蒽环类药物性心肌病病儿5例诊治体会并文献复习  

EXPERIENCE IN THE DIAGNOSIS AND TREATMENT OF ANTHRACYCLINE-INDUCED CARDIOMYOPATHY IN CHILDREN:A REPORT OF FIVE CASES AND LITERATURE REVIEW

作　　者：冯嵩[1] 张小建 陈晓光[1] 安金斗[1] FENG Song;ZHANG Xiaojian;CHEN Xiaoguang;AN Jindou(Department of Pediatrics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿内科,河南郑州450052

出　　处：《精准医学杂志》2018年第5期407-410,413,共5页Journal of Precision Medicine

基　　金：河南省医学科技攻关计划项目(201503077)

摘　　要：目的提高对蒽环类药物致儿童心肌病的认识。方法 2015—2017年在我科住院诊治的蒽环类药物性心肌病病儿5例,分析其临床表现、治疗和随访情况,并进行文献复习。结果蒽环类药物性心肌病病儿5例,男2例,女3例,年龄3～12岁;柔红霉素累积剂量为270～640mg/m^2;于末次化疗结束2月～2年后出现咳嗽、恶心、乏力和呼吸困难等症状。心电图、心脏超声检查及血浆中氨基末端脑钠肽前体水平显著异常。应用纠正心力衰竭的药物后,3例病儿症状消失,心功能部分恢复,随访时间为6～34个月;2例病儿症状反复出现,心功能改善差,分别随访2、6个月后失访。结论蒽环类药物性心肌病预后不良,早期识别易发生心脏毒性的病儿,早期进行干预,可能改善预后。Objective To improve the understanding of anthracycline-induced cardiomyopathy in children.Methods A retrospective analysis was performed for the clinical manifestations,treatment,and follow-up data of 5 children with anthracycline-induced cardiomyopathy who were hospitalized and treated in our department from 2015 to 2017,and a literature review was also performed.Results Among the 5 children with anthracycline-induced cardiomyopathy,2 were boys and 3 were girls,with an age of 3-12 years.The cumulative dose of daunomycin ranged from 270 to 640 mg/m 2.They developed the symptoms of cough,nausea,weakness,and dyspnea within 2 months to 2 years after the end of the last chemotherapy.There were significant abnormalities in the results of electrocardiography and heart ultrasound examination and the level of N-terminal pro-brain natriure-tic peptide in plasma.After the intensive heart failure therapy,3 children achieved the disappearance of symptoms and the partial recovery of cardiac function and were followed up for 6-34 months;2 children had recurrent symptoms and poor improvement in cardiac function and were lost to follow-up after 2 and 6 months,respectively,of follow-up.Conclusion Anthracycline-induced cardiomyopathy has a poor prognosis.Early identification and intervention of children prone to cardiac toxicity may improve prognosis.

关 键 词：心肌疾病 蒽环类 心脏毒性 诊断 治疗结果 儿童 

分 类 号：R542.2[医药卫生—心血管疾病]