乳腺癌放疗患者临床心电图分析  

Clinical ECG analysis of patients with breast cancer after radiotherapy

作　　者：付争艳 尹希[1] 耿旭红[1] 潘烁 周凯 赵鹏[1] FU Zhengyan;YIN Xi;GENG Xu-hong;PAN Shuo;ZHOU Kai;ZHAO Peng(Department of Function,the Fourth Hospital of Hebei Medical Uni-versity,Shijiazhuang Hebei 050011,China)

机构地区：[1]河北医科大学第四医院功能科,河北石家庄050011

出　　处：《实用心电学杂志》2022年第4期253-255,271,共4页Journal of Practical Electrocardiology

基　　金：河北省卫生厅重点课题研究计划项目(20130544)。

摘　　要：目的分析乳腺癌放疗患者的心电图改变及其临床意义。方法回顾性分析我院103例乳腺癌患者放疗前(A组)、放疗后3个月内(B组)及放疗后3个月以上(C组)的心电图指标:心率、PR间期、QRS波时限、QT间期、QTc、Sokolow-Lyon指数以及ST段和T波。结果放疗后PR间期逐渐延长,C组与A组比较差异有统计学意义(P<0.01);放疗后QRS波时限逐渐延长,C组与A、B组比较,差异均有统计学意义(P均<0.01);QTc逐渐缩短,但三组间的差异无统计学意义;Sokolow-Lyon指数B组较A组降低,差异有统计学意义(P<0.01);放疗后T波较放疗前出现明显低平倒置改变者占比高达33.0%,放疗前后T波异常患者例数间的差异有统计学意义(P<0.05)。结论放疗前后心电图指标的改变提示可能存在心肌传导和除极的改变,T波的异常或许提示早期心肌供血异常等问题。这些改变多不伴有临床表现,但可早期提示乳腺癌患者存在放疗引起的心肌损伤。定期心电图监测可能有助于在放疗后的随访期间检测早期心脏毒性。Objective To analyze the ECG changes and their clinical significance in patients with breast cancer after radiotherapy.Methods Retrospective analysis was performed on 103 patients with breast cancer.The ECG indexes of heart rate,PR interval,QRS duration,QT interval,QTc,Sokolow-Lyon index(SLI),ST segment and T wave before radiotherapy(group A),within 3 months after radiotherapy(group B)and more than 3 months after radiotherapy(group C)were analyzed.Results After radiotherapy,PR interval is gradually extended and there is statistically significant difference between group A and group C(P<0.01);QRS duration is gradually prolonged,and QRS duration of group C varies significantly from either group A or group B(P<0.01);QTc is gradually reduced,however,QTc of group C does not vary significantly from either group A or group B.SLI in group B is lower than that in group A with statistically significant difference(P<0.01).After radiotherapy,the patients with significantly low,flat and inverted T wave compared with that before radiotherapy account for as high as 33.0%.The difference of the number of patients with T wave abnormalities before and after radiotherapy is statistically significant(P<0.05).Conclusion Changes of ECG indexes before and after radiotherapy may indicate changes of myocardial conduction and depolarization;abnormal T wave may indicate problems such as abnormal myocardial blood supply in an early stage.These changes are mostly not accompanied with clinical manifestations,but may indicate radiotherapy induced myocardial damage among breast cancer patients in an early stage.Regular ECG monitoring might aid in detecting early cardiotoxicity during follow-up after radiotherapy.

关 键 词：心电图 放射治疗 乳腺癌 肿瘤学 肿瘤心脏病学 

分 类 号：R737.9[医药卫生—肿瘤] R540.41[医药卫生—临床医学]