Tp-Te间期对蒽环类化疗乳腺癌患者室性心律失常的预测价值  

Predictive value of Tp-Te interval on ventricular arrhythmias in patients with breast cancer treated by anthracycline-based chemotherapy

作　　者：陈心玥 王璐洁 赵夕黎 杜海蓉 再米拉·阿布力米提 王蕊 CHEN Xinyue;WANG Lujie;ZHAO Xili;DU Hairong;ABULIMITI Zaimila;WANG Rui(The Third Clinical Medical School,Xinjiang Medical University,Urumqi Xinjiang 830011,China)

机构地区：[1]新疆医科大学第三临床医学院,新疆乌鲁木齐830011

出　　处：《实用心电学杂志》2023年第6期395-399,共5页Journal of Practical Electrocardiology

基　　金：新疆医科大学科研创新基金资助项目(CX2021078)。

摘　　要：目的探讨Tp-Te间期及Tp-Te/QT比值等心电图指标的变化与以蒽环类药物为基础首次化疗乳腺癌患者室性心律失常发生的相关性及其预测价值。方法纳入确诊的乳腺癌患者150例,均为女性,所有患者首次化疗均采用蒽环类药物化疗方案。根据治疗后是否发生室性心律失常分为无室性心律失常组(心律正常组,n=90)、室性心动过速组(室速组,n=26)和室性早搏组(室早组,n=34)。对比各组患者治疗前一般临床资料(年龄、吸烟史、糖尿病史、高血压病史、血红蛋白、总胆固醇、甘油三酯、HDL-C、LDL-C、K^(+)、Na^(+)、Ca^(2+))及治疗前后心电相关指标(QT间期、Tp-Tec、Tp-Te/QT)。通过相关性分析及受试者工作特征曲线(receiver operating characteristic curve,简称ROC曲线),分析心电相关指标对乳腺癌患者治疗后发生室性心动过速及室性早搏的预测价值。结果治疗后室速组和室早组患者QTc、Tp-Tec及Tp-Te/QT较治疗前均显著升高,且均高于心律正常组患者,其中室速组患者各心电相关指标升高最明显(P均<0.05)。Spearman相关性分析表明,QT间期、Tp-Tec及Tp-Te/QT均与乳腺癌患者治疗后发生室性心动过速、室性早搏具有显著正相关性(P<0.05)。ROC曲线分析表明,Tp-Tec对乳腺癌患者发生室性心动过速、室性早搏的预测价值均明显高于QTc和Tp-Te/QT,最佳界值分别为93.54、83.07 ms。结论QT间期、Tp-Te间期及Tp-Te/QT比值对以蒽环类化疗药物为基础方案的首次化疗乳腺癌患者室性心律失常的发生均有一定预测价值,且Tp-Te间期的预测价值最高,未来可能作为重要心电指标应用于临床以实现早期预测、评估乳腺癌化疗患者室性心律失常的发生风险,为乳腺癌的及早预防、治疗提供理论依据。Objective To explore the correlation between Tp-Te interval,Tp-Te/QT ratio and other ECG indexes,and the occurrence of ventricular arrhythmias in patients with breast cancer first treated by anthracyclinebased chemotherapy,and to investigate the predictive value of these ECG indexes.Methods A total of 150 females diagnosed with breast cancer were enrolled.All patients were treated by anthracycline chemotherapy.According to the occurrence of ventricular arrhythmias after treatment,these patients were divided into three groups:non-ventricular arrhythmia group(n=90),ventricular tachycardia group(n=26)and premature ventricular contraction(PVC)group(n=34).The general clinical data(including age,smoking history,diabetes history,hypertension history,Hb,TC,TG,HDL-C,LDL-C,K^(+),Na^(+)and Ca^(2+)),and ECG related indexes(including QT interval,Tp-Tec and Tp-Te/QT)before and after treatment were compared among groups.Correlation analysis and receiver operating characteristic curve(ROC curve)were used to analyze the predictive value of ECG related indexes on the occurrence of ventricular tachycardia and PVC in patients with breast cancer after treatment.Results After treatment,the values of QTc,Tp-Tec and Tp-Te/QT in patients of the ventricular tachycardia group and the PVC group are all significantly increased(P<0.05);these values are all higher than those in the normal controls(P<0.05).Patients in the ventricular tachycardia group have the most obvious increase of ECG related indexes(P<0.05).Spearman correlation analysis shows that QT interval,Tp-Tec and Tp-Te/QT are all significantly positively correlated with the occurrences of ventricular tachycardia and PVC in patients with breast cancer after treatment.ROC curve analysis indicates that the predictive value of Tp-Tec on the occurrences of ventricular tachycardia and PVC in patients with breast cancer is significantly higher than that of QTc and Tp-Te/QT;the best cut-off values are 93.54 and 83.07 ms,respectively.Conclusion QT interval,Tp-Te interval and Tp-Te/QT ratio h

关 键 词：TP-TE间期 乳腺癌 蒽环类化疗药物 室性早搏 室性心动过速 毒性反应 

分 类 号：R541.7[医药卫生—心血管疾病] R979.1[医药卫生—内科学]