24 h动态心电图联合cTnT、CK-MB在评价胸部恶性肿瘤患者放射性心脏损伤中的应用价值  

Diagnostic utility of 24-hour ambulatory electrocardiography combined with cardiac troponin T and creatine kinase-MB in assessing radiation-induced heart injury in patients with thoracic malignancies

作　　者：陈颖妹 翟任群[1] 周菲[2] Chen Yingmei;Zhai Renqun;Zhou Fei(ECG Room,Hainan General Hospital,Hainan Hospital Affiliated to Hainan Medical College,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院心电图室,海口570311 [2]海南省人民医院/海南医学院附属海南医院心内科,海口570311

出　　处：《中华保健医学杂志》2024年第5期565-568,共4页Chinese Journal of Health Care and Medicine

基　　金：海南省卫生健康行业科研项目(22A200019)。

摘　　要：目的探讨24 h动态心电图联合肌钙蛋白T(cTnT)、磷酸激酶同工酶MB(CK-MB)在评价胸部恶性肿瘤患者放疗诱发放射性心脏损伤(RIHD)中的应用价值。方法选取2018~2022年于海南医学院附属海南医院接受放疗的116例胸部恶性肿瘤患者,分别于不同时间(放疗前、放疗结束、放疗结束后3个月)行常规心电图、24 h动态心电图、心脏彩超、cTnT、CK-MB检查。根据是否出现RIHD将患者分成RIHD组(41例)和非RIHD组(75例)。比较两组患者放疗前、放疗结束时、放疗结束后3个月的cTnT、CK-MB水平,以及24 h动态心电图、常规心电图、心脏彩超、cTnT、CK-MB单项检测及24 h动态心电图、cTnT、CK-MB三者联合检测对胸部恶性肿瘤患者RIHD的评估价值。结果放疗前,RIHD组与非RIHD组的cTnT[(0.185±0.028)μg/L vs.(0.193±0.025)μg/L]、CK-MB[(19.21±4.07)U/L vs.(18.55±3.52)U/L]水平比较,差异均无统计学意义(t=1.579、1.913,P>0.05)。不同时间(放疗前、放疗结束时、放疗结束3个月)的cTnT、CK-MB水平比较,差异均有统计学意义(F=932.30、293.93,P<0.05)。LSD-t检验结果显示,放疗结束时、放疗结束后3个月,两组患者的cTnT、CK-MB水平均较放疗前升高,且RIHD组患者的cTnT、CK-MB水平均高于非RIHD组患者,差异均有统计学意义(P<0.05)。放疗结束后3个月,常规心电图检查与临床综合诊断结果的一致性较差(Kappa=0.306,P<0.05);24 h动态心电图检查、心脏彩超检查、cTnT、CK-MB单项检测具有中等一致性(Kappa=0.401、0.437、0.541、0.418,P<0.05);24 h动态心电图、cTnT、CK-MB联合检测的一致性最好(Kappa=0.796,P<0.05)。不同检测方法(24 h动态心电图、cTnT、CK-MB)联合评估的灵敏度、特异度、一致性、阳性预测值、阴性预测值均最高,即联合检测的真实性、可靠性、预测值均高于单项检测。结论24 h动态心电图联合cTnT、CK-MB评价胸部恶性肿瘤患者放疗诱发RIHD的真实性、可靠性、预测值�Objective This study aimed to evaluate the diagnostic utility of combining 24-hour ambulatory electrocardiography(Holter monitoring)with cardiac troponin T(cTnT)and creatine kinase-MB(CK-MB)for assessing radiation-induced heart injury(RIHD)in patients undergoing chest radiotherapy.Methods We selected 116 patients with thoracic malignancies treated with radiotherapy at Hainan General Hospital Affiliated to Hainan Medical College from 2018 to 2022.They underwent routine electrocardiography,24-hour ambulatory electrocardiography,echocardiography,and serum levels of cTnT and CK-MB before radiotherapy,at the end of radiotherapy,and three months post-radiotherapy.Patients were categorized into RIHD and non-RIHD groups based on the presence of RIHD.We compared the cTnT and CK-MB levels,as well as the diagnostic value of individual and combined assessments of 24-hour ambulatory electrocardiography,cTnT,and CK-MB for RIHD.Results Prior to radiotherapy,there were no significant differences in cTnT[(0.185±0.028)μg∕L vs.(0.193±0.025)μg∕L]and CK-MB[(19.21±4.07)U∕L vs.(18.55±3.52)U∕L]levels between the RIHD and non-RIHD groups(t=1.579,1.913,P>0.05).However,the levels of cTnT and CK-MB at different time points(before,at the end of,and three months post-radiotherapy)showed significant differences(F=932.30,293.93,P<0.05).Post hoc LSD-t tests indicated that both groups had increased cTnT and CK-MB levels after radiotherapy and at three months,with the RIHD group showing higher levels than the non-RIHD group,which was statistically significant(P<0.05).At three months post-radiotherapy,the agreement between routine electrocardiography and clinical diagnosis was poor(Kappa=0.306,P<0.05),while 24-hour ambulatory electrocardiography,echocardiography,and individual tests of cTnT and CK-MB showed moderate agreement(Kappa=0.401,0.437,0.541,0.418,P<0.05).The combined assessment of 24-hour ambulatory electrocardiography,cTnT,and CK-MB demonstrated the best agreement(Kappa=0.796,P<0.05).The sensitivity,specificity,consistency,p

关 键 词：放射性心脏损伤 24 h动态心电图 肌钙蛋白T 磷酸激酶同工酶MB 胸部肿瘤 

分 类 号：R730.55[医药卫生—肿瘤]