动态心电图评价舒尼替尼对肾细胞癌患者心脏毒性的临床价值  

Clinical value of dynamic electrocardiogram in evaluating the cardiotoxicity of sunitinib to patients with renal cell carcinoma

作　　者：万建平[1] 杨泽福[1] 高耀铭[2] WAN Jianping;YANG Zefu;GAO Yaoming(The People's Hospital of Nanhai District in Foshan City,Guangdong,Foshan 528000,China;The First People's Hospital of Foshan,Guangdong,Foshan 528000,China)

机构地区：[1]广东省佛山市南海区人民医院,广东佛山528000 [2]广东省佛山市第一人民医院,广东佛山528000

出　　处：《中国医药科学》2021年第23期190-194,共5页China Medicine And Pharmacy

基　　金：广东省佛山市科技创新项目(2020001005213)。

摘　　要：目的探讨动态心电图评价舒尼替尼对肾细胞癌(RCC)患者心脏毒性的临床价值。方法选取2019年2月至2021年3月佛山市南海区人民医院及佛山市第一人民医院接受舒尼替尼治疗的RCC患者96例,均于治疗前、治疗1个周期后检测动态心电图,根据1年内是否出现心脏毒性事件分为心脏毒性组(24例)、无心脏毒性组(72例),另选取同期48例健康体检者作为对照组,并进行动态心电图检测。比较三组一般资料及动态心电图参数[心率减速力(DC)、心率加速力(AC)、心率变异性(HRV)],分析动态心电图参数与左室射血分数(LVEF)间关系及对心脏毒性的预测价值。结果三组吸烟情况、饮食习惯比较,差异有统计学意义(P<0.05);治疗1个周期心脏毒性组LVEF、DC、全部窦性心博RR间期(SDNN)、连续5 min节段平均RR间期的标准差(SDANN)、相邻RR间期之差的均方根(RMSSD)低于无心脏毒性组,AC高于无心脏毒性组(P<0.05);RCC患者治疗后DC、SDNN、SDANN、RMSSD与LVEF呈正相关,AC与LVEF呈负相关(P<0.05);logistic回归方程校正吸烟、常食肉食混杂因素后,LVEF、DC、AC、SDNN、SDANN、RMSSD仍与RCC患者心脏毒性发生有关(P<0.05)。结论动态心电图参数变化与RCC患者心脏毒性发生关系密切,可为临床评估舒尼替尼对RCC患者心脏毒性提供新视角。Objective To explore the clinical value of dynamic electrocardiogram(DECG)in evaluating the cardiotoxicity of sunitinib to patients with renal cell carcinoma(RCC).Methods A total of 96 RCC patients who were treated with sunitinib in the People's Hospital of Nanhai District in Foshan City and the First People's Hospital of Foshan from February 2019 to March 2021 were selected as research objects,and their DECG was detected before and after one cycle of treatment.They were divided into the cardiotoxic group(n=24)and the non-cardiotoxic group(n=72)according to whether there were any cardiotoxic events within one year.In addition,48 healthy people in the same period were selected as the control group and the DECG was detected as well.The general data and DECG parameters(deceleration capacity of rate[DC],acceleration capacity of rate[AC],heart rate variability[HRV])of the three groups were compared,and the relationship between DECG parameters and left ventricular ejection fraction(LVEF)and its predictive value for cardiotoxicity were analyzed.Results There were statistically significant differences in smoking and eating habits among the three groups(P<0.05).After one cycle of treatment,the LVEF,DC,standard deviation of normal-to-normal intervals(SDNN),standard deviation of averaged normal–to-normal intervals(SDANN)and root mean square values of the standard deviation between adjacent normal number of intervals(RMSSD)in the cardiotoxic group were lower than those in the non-cardiotoxic group and the AC was higher than that in the non-cardiotoxic group(P<0.05).After treatment,DC,SDNN,SDANN and RMSSD of RCC patients were positively correlated with LVEF,while AC was negatively correlated with LVEF(P<0.05).After adjusting for smoking and meat ate frequently by logistic equation,LVEF,DC,AC,SDNN,SDANN and RMSSD were still related to the occurrence of cardiotoxicity in RCC patients(P<0.05).Conclusion The change of DECG parameters is closely related to the occurrence of cardiotoxicity in RCC patients,which can provide a new

关 键 词：动态心电图 肾细胞癌 心脏毒性 心率减速力 心率变异性 

分 类 号：R737.11[医药卫生—肿瘤]