心电图QT间期离散度对乳腺癌患者调强放疗后心肌损伤的诊断价值  

Diagnostic value of QT interval dispersion of electrocardiogram for myocardial injury after intensity modulated radiotherapy in patients with breast cancer

作　　者：申媛媛 李彦慧 程慧磊 SHEN Yuanyuan;LI Yanhui;CHENG Huilei(Department of Cardiac function,Zhengzhou People's Hospital,Zhengzhou 450053,China)

机构地区：[1]郑州人民医院心功能科,450053

出　　处：《心电与循环》2023年第1期57-60,65,共5页Journal of Electrocardiology and Circulation

摘　　要：目的 探讨心电图QT间期离散度(QT-cd)对乳腺癌患者调强放疗后心肌损伤的诊断价值。方法 选择2019年8月至2021年8月在郑州人民医院就诊的乳腺癌患者124例作为观察组,另择同期健康体检者55名作为对照组。观察组患者进行保乳手术并行调强放疗。比较观察组放疗前后及两组心脏标志物[肌酸激酶同工酶(CK-MB)、肌钙蛋白I(c TnI)、C反应蛋白(CRP)]水平,心电图检查参数(QT-cd、心率)及心脏超声指标[左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、二尖瓣口舒张早期最大峰值/舒张晚期最大峰值(E/A)],分析心电图检查参数与上述指标的相关性及对调强放疗后心肌损伤的诊断价值。结果 与对照组、观察组放疗前比较,观察组放疗后QT-cd、心率、CK-MB、c TnI、CRP、LVEDV、LVESV较高,LVEF、E/A较低,差异均有统计学意义(均P<0.05)。经Pearson相关性分析,观察组放疗后QT-cd、心率与CK-MB、cTnI、CRP、LVEDV和LVESV均呈正相关(均P<0.05),与LVEF和E/A均呈负相关(均P<0.05)。QT-cd和心率联合诊断调强放疗后心肌损伤的AUC优于单一指标诊断。结论 心电图QT-cd可用于评估乳腺癌调强放疗后心肌损伤及心功能。Objective To investigate the diagnostic value of QT interval dispersion(QT-cd) of electrocardiogram for myocardial injury after intensity modulated radiotherapy in patients with breast cancer. Methods A total of 124 breast cancer patients treated in Zhengzhou People’s Hospital from August 2019 to August 2021 were assigned to an observation group. Meanwhile, 55 healthy people were assigned to a control group. Patients in the observation group were treated with breast-conserving surgery and intensity modulated radiotherapy. Cardiac biomarkers [creatine kinase MB isoenzyme(CK-MB), cardiac troponin I(cTnI), C-reactive protein(CRP)], electrocardiogram parameters(QT-cd, heart rate) and echocardiographic parameters [left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF), early diastolic peak of mitral valve orifice/late diastolic peak(E/A)] in the observa-tion group before and after radiotherapy and in the control group were compared.The correlation between ECG parameters and the above other parameters, and the diagnostic value of ECG for myocardial injury after intensity-modulated radiotherapy were analyzed. Results QT-cd, heart rate, CK-MB, c TnI,CRP, LVEDV and LVESV were significantly higher, LVEF and E/A were significantly lower in the observation group after radiotherapy than before radiotherapy and the control group(all P<0.05). Pearson correlation analysis showed that QT-cd and heart rate were positively correlated with CK-MB, c TnI, CRP, LVEDV and LVESV(all P <0.05), and negatively correlated with LVEF and E/A in the observation group after radiotherapy(all P <0.05). The AUC of QT-cd in combination with heart rate for diagnosis of myocardial injury after intensity-modulated radiotherapy was higher than that of each one. Conclusion QT-cd of electrocardiogram can be used to evaluate myocardial injury and cardiac function after intensity modulated radiotherapy for breast cancer.

关 键 词：乳腺癌 放疗 心电图 心肌损伤 

分 类 号：R737.9[医药卫生—肿瘤]