不同年龄乳腺癌患者蒽环类化疗期间心电图监测结果分析  

Analysis of electrocardiogram monitoring results during anthracyclines-related chemotherapy in patients with breast cancer of different ages

作　　者：李智宇 罗玲 王钟 Li Zhiyu;Luo Ling;Wang Zhong(Department of Breast and Thyroid Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院乳腺甲状腺外科,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2024年第5期338-341,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：中央高校基本科研业务费专项资金青年教师资助项目(2042023kf0020);湖北省重点实验室开放项目(2023KFZZ008)。

摘　　要：目的 探讨不同年龄乳腺癌患者经多次心电图监测评估蒽环类化疗方案的心脏毒性作用的可能性。方法 选取本院2020年1月至2023年1月间经穿刺或手术病理初次确诊为乳腺癌(未发生远处转移)并接受4AC-4T化疗方案的患者,根据年龄分为老年组(≥60岁)和非老年组(<60岁),记录化疗前、化疗期、恢复期十二导联心电图的变化。结果 共纳入212例乳腺癌患者,平均(52.83±10.32)岁,其中老年组87例,非老年组125例。两组患者化疗前心电图均正常,病理分期及心电图参数组间均无显著差异。化疗期所有患者的心电图异常总体阳性发生率为41.0%(87/212),老年组的心电图异常改变发生比例为51.7%(45/87),显著高于非老年组[33.6%(42/125)],主要表现为ST-T改变及不同类型心律失常,后者包括窦性心动过速、窦性心动过缓,房性早搏,室性早搏,房室传导阻滞,束支传导阻滞,无心房颤动,房性和室性心动过速发生。恢复期两组心电图异常比例均降低,老年组仍高于非老年组[31.0%(27/87) vs 16.8%(21/125),P<0.05]。结论 蒽环类化疗方案对乳腺癌患者的心电图有显著影响,老年人群更易出现心电图异常,化疗期间多次监测心电图有利于评估化疗过程中潜在的药物相关心脏毒性作用。Objective To explore the possibility of multiple ECG monitoring during chemotherapy to evaluate the cardiac toxicity in patients with breast cancer of different ages.Methods Patients diagnosed with breast cancer by puncture or surgical pathology(without distant metastasis)and received 4AC-4T chemotherapy were selected in our hospital from Janu-ary 2020 to January 2023.According to the age the patients were divided into elderly group(≥60 years old)and non-elder-ly group(<60 years old).The changes of 12-lead ECG before,during and after chemotherapy were observed and com-pared between the two groups.Results A total of 212 patients with breast cancer were enrolled,with an average age of(52.83±10.32)years,including 87 patients in elderly group and 125 patients in non-elderly group.Both groups of patients had normal electrocardiograms before chemotherapy,and there were no significant differences in pathological staging and e-lectrocardiogram parameters.After chemotherapy,the incidence of abnormal ECG was 41.0%(87/212)in all patients.The proportion of abnormal ECG changes in the elderly group was higher than that in the non-elderly group[51.7%(45/87)vs 33.6%(42/125),P<0.05].The main abnormal manifestations were ST-T changes and arrhythmias,the latter including sinus tachycardia,sinus bradycardia,atrial or ventricular premature beats,atrioventricular block,bundle branch block,no occurrence of atrial fibrillation,atrial or ventricular tachycardia were recorded.During the recovery period,the proportion of abnormal ECG changes decreased in both groups,which was still higher in the elderly group as compared with non elderly group[31.0%(27/87)vs 16.8%(21/125),P<0.05].Conclusion Chemotherapy has a significant effect on the ECG changes in breast cancer patients,and the elderly population is more prone to ECG abnormalities.Special attention should be paid to the prevention and treatment of drug-related cardiotoxicity during chemotherapy.Multiple ECG monitoring during chemotherapy is beneficial for evaluating the potential ant

关 键 词：心血管病学 乳腺癌 化疗 蒽环类 心电图 心脏毒性 年龄 

分 类 号：R540.41[医药卫生—心血管疾病] R731.9[医药卫生—内科学]