蒽环类药物致乳腺癌患者校正QT间期延长的发生率及危险因素分析  

Incidence and risk factors of the corrected QT prolongation in breast cancer patients induced by anthracyclines

作　　者：董新江 尚茹茹 刘晓红 Dong Xinjiang;Shang Ruru;Liu Xiaohong(VIP Ward,People′s Hospital Affiliated to Shanxi Medical University,Taiyuan 030012,China)

机构地区：[1]山西医科大学附属人民医院特需病房,太原030012

出　　处：《中华全科医师杂志》2020年第6期507-511,共5页Chinese Journal of General Practitioners

摘　　要：目的观察乳腺癌患者使用蒽环类药物治疗过程中出现的校正QT间期(QTc)延长的发生率及影响因素。方法回顾性分析2017年7月至2019年1月在山西医科大学附属人民医院乳腺科接受4个周期蒽环类药物治疗的279例女性乳腺癌患者的临床资料。患者治疗前心电图均为窦性心律且QTc<440 ms,收集治疗后心电图发现最常见的心电图异常为QTc的变化。将QTc≥440 ms判定为延长,其中78例QTc延长(QTc延长组),201例无QTc延长(QTc未延长组)。对两组间的临床资料,行单因素和多因素logistic回归分析QTc延长的影响因素,对差异有统计学意义的影响因素计算QTc延长发生率。根据患者治疗期间出现的心脏毒性症状和心电图结果评估心脏毒性。结果治疗后发生常见的心电图异常为78例(28.0%)QTc延长,22例(7.9%)ST-T改变,18例(6.5%)窦性心动过缓等。单因素分析结果显示,QTc延长组和QTc未延长组间使用蒽环类药物治疗(表柔比星48与73例,吡柔比星10与33例,多柔比星4与12例,多柔比星脂质体16与83例),使用右雷佐生治疗(4与31例),伴有冠心病(4与2例)、超重/肥胖(42与80例)方面比较,差异均有统计学意义(χ2=15.54,P<0.01;χ2=5.43,P=0.02;χ2=4.56,P=0.03;χ2=4.51,P=0.03)。多因素logistic回归分析结果显示,使用不同种类的蒽环类药物(OR=1.42,95%CI:1.37~1.48,P=0.02)和超重/肥胖(OR=1.23,95%CI:1.16~1.30,P=0.04)与QTc延长发生率呈正相关。蒽环类药物中致QTc延长发生率多柔比星脂质体治疗者最低,为16.2%(16/99),表柔比星治疗者最高,为39.7%(48/121)。预防使用右雷佐生治疗者QTc延长发生率降为11.4%(4/35)。乳腺癌伴有冠心病或超重/肥胖导致QTc延长的发生率较高,分别为4/6和34.4%(42/122)。治疗期间均未出现胸痛、心悸、气短等心脏毒性症状,心电图未记录到室性心动过速、室性纤维颤动等致命性心律失常。结论蒽环类药物治疗乳腺癌虽然QTc延长的发生率较高,Objective To study the incidence and risk factors of the corrected QT(QTc)prolongation in breast cancer patients treated with anthracyclines.Methods From July 2017 to January 2019,279 female breast cancer patients who underwent 4 cycles of anthracycline treatment in Department of Breast Surgery of the People′s Hospital of Shanxi Medical University were enrolled in the study.The ECG of all patients before treatment showed sinus rhythm and QTc<440 ms.The most common electrocardiographic abnormalities after treatment were the changes of QTc.There were 78 cases with prolonged QTc(≥440 ms,QTc prolongation group)and 201 cases with normal QTc(<440 ms,non-prolongation group).The risk factors of QTc prolongation were analyzed by univariate and multivariate logistic regression.Cardiac toxicity was evaluated according to clinical symptoms and ECG results during treatment.Results The common ECG abnormalities after treatment were 78 cases of QTc prolongation(28.0%),22 cases of ST-T changes(7.9%),and 18 cases of sinus bradycardia(6.5%).Univariate analysis showed that there were significant differences in administration of anthracyclines(contained epirubicin in 48 and 73 cases,pirubicin in 10 and 33 cases,doxorubicin in 4 and 12 cases,liposomal doxorubincin in 16 and 83 cases,χ2=15.54,P<0.01),dexrazoxane use(χ2=5.43,P=0.02),coronary heart disease(χ2=4.56,P=0.03),obesity or overweight(χ2=4.51,P=0.03)between two groups.Multivariate logistic regression analysis showed that the use of different types of anthracyclines(OR=1.42,95%CI:1.37-1.48,P=0.02)and overweight/obesity(OR=1.23,95%CI:1.16-1.30,P=0.04)were independent risk facors of QTc prolongation.The liposomal doxorubicin in anthracyclines resulted in a minimum incidence of the QTc prolongation(16.2%,16/99),while that of epirubicin was up to 39.7%(48/121).Preventive use of dexrazoxane reduced the incidence of the QTc prolongation to 11.4%(4/35).The incidence of the QTc prolongation in breast cancer with coronary heart disease or overweight/obesity was relatively high,whi

关 键 词：QT延长综合征 蒽环类 乳腺肿瘤 影响因素 

分 类 号：R737.9[医药卫生—肿瘤]