淋巴瘤患者化疗周期与心电图异常关系的探索  

The study on the relationship between the number of chemotherapy cycles and abnormal electrocardiogram in the patients with lymphoma

作　　者：周清芬[1] 任妍[2] 王玲洁[1] 张凤如[2] ZHOU Qingfen;REN Yan;WANG Lingjie;ZHANG Fengru(Department of Cardiology;Department of Geratology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院心脏科,上海200025 [2]上海交通大学医学院附属瑞金医院老年病科,上海200025

出　　处：《内科理论与实践》2020年第5期337-340,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨淋巴瘤患者化疗周期与心电图异常发生率之间的关系。方法 :入组262例淋巴瘤患者,包括R-CHOP(利妥昔单抗、环磷酰胺、长春新碱、多柔比星脂质体、泼尼松)化疗组169例、ABVD(多柔比星脂质体、博来霉素和达卡巴嗪)化疗组34例等,按化疗周期分为化疗≤3次、3次<化疗≤6次、化疗>6次3个阶段,分别统计所有淋巴瘤、R-CHOP方案、ABVD方案患者在各阶段的心电图异常发生率,探究化疗周期与心电图异常发生率之间的关系。结果:262例淋巴瘤患者化疗前心电图异常发生率为46.6%,化疗后心电图异常发生率为69.5%(P<0.05),且随着化疗周期增加,3个阶段的心电图异常发生率逐步增加(P<0.05);R-CHOP化疗组中,随着化疗周期增加,3个阶段的心电图异常发生率也逐步增加(P<0.05)。221例淋巴瘤患者化疗后左心房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)及左心室收缩末期内径(left ventricular end systolic diameter,LVESD)增大,左心室射血分数(left ventricular ejection fraction,LVEF)降低(均P<0.05),其中6例(2.7%)出现扩张型心肌病;化疗期间QRS间期与LVEDD变化呈正相关(r=0.193,P=0.000)。所有患者化疗前、后ST-T改变分别为9例(3.4%)、32例(12.2%)(P<0.05),化疗前、化疗后发生心律失常分别为64例(24.4%)和96例(36.6%)(P<0.05)。结论:随着化疗周期增加,淋巴瘤患者心电图异常发生率呈逐步升高趋势。化疗药物对淋巴瘤患者的心脏不良反应有累积效应,因此密切监测心电图有助于早期筛查心血管受损表现。Objective To explore the relationship between the chemotherapy cycles and the incidence of abnormal electrocardiogram(ECG) in the patients with lymphoma. Methods The ECG of 262 patients with lymphoma, including 169 cases received chemotherapy of R-CHOP(rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) and 34 cases treated with ABVD(doxorubicin, bleomycin, vinblastine and dacarbazine) were divided into three stages according to the cycles of chemotherapy: chemotherapy ≤3 times, 3 times<chemotherapy ≤6 times and chemotherapy >6 times. In each stage,the incidence of abnormal ECG in all patients, the patients with R-CHOP or ABVD treatment was counted to evaluate the relationship between the cycles of chemotherapy and the incidence of abnormal ECG. Results In 262 patients with lymphoma, the incidence of abnormal ECG before and after chemotherapy increased from 46.6% to 69.5%(P<0.05). With the increase of chemotherapy cycle, the incidence of ECG abnormalities in three stages increased gradually(P<0.05). In 169 patients with R-CHOP therapy, the incidence of ECG abnormalities in three stages also elevated gradually following the increase of chemotherapy cycle(P<0.05). After chemotherapy, 221 patients showed significantly increased the left atrial diameter(LAD), left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD) and decreased left ventricular ejection fraction(LVEF)(P<0.05), in which 6 cases(2.7%) developed into dilated cardiomyopathy. There was a positive correlation between the QRS interval in ECG and the change of LVEDD in ultrasound cardiogram(r=0.193, P=0.000) during chemotherapy. In all 262 patients, ST-T change before and after chemotherapy was observed in 9 cases(3.4%) and 32 cases(12.2%) respectively(P<0.05), and the arrhythmia was showed in 64 cases(24.4%) and 96 cases(36.6%) respectively. Conclusions With the increasing cycle of chemotherapy, the incidence of abnormal ECG in lymphoma patients increased gradually and the chemotherapeutic drugs sh

关 键 词：淋巴瘤 化疗周期 心电图异常 

分 类 号：R563.1[医药卫生—呼吸系统]