放疗中心脏照射剂量体积与自主神经功能紊乱关系的研究  

A study of relationship between cardiac exposure dose-volume and cardiovascular autonomic dysfunction in radiotherapy

作　　者：陈虹宇 苏鹏宇 罗文姿 庞得全 王斐然 CHEN Hongyu;SU Pengyu;LUO Wenzi;PANG Dequan;WANG Feiran(Department of Radiotherapy,Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,Hebei Province,China)

机构地区：[1]华北理工大学附属医院放疗科,河北唐山063000

出　　处：《中国癌症杂志》2024年第11期1036-1044,共9页China Oncology

基　　金：河北省医学科学研究课题(20240574)。

摘　　要：背景与目的:晚期癌症患者心脏自主神经功能紊乱(autonomic dysfunction,AD)的发生率为65%~80%,AD导致的头晕、心悸及疲乏等神经衰弱症状,即使充分休息也难以缓解,严重影响患者的生存质量。同时,心血管自主神经系统对心率、心肌功能和心肌血流具有重要调节作用,AD会增加患者心血管疾病的发病率和死亡风险。AD不仅是一种功能状态,而且可能是整体心肌病变的早期标志。研究显示,在调整年龄、性别和心血管危险因素后,先前的辐射暴露与静息心率增高及运动后心率恢复异常等AD表现相关,但是目前放疗对心脏自主神经功能影响的相关研究尚少,具体的损伤效应及损伤发生的剂量阈值尚不明确。本研究通过对比放疗前后的心率变异性(heart rate variability,HRV)分析参数差异,探讨胸部放疗对恶性肿瘤患者心脏自主神经功能的影响,通过对比病例组和对照组间的剂量学差异,探索发生AD的剂量学相关危险因素,为优化放疗方案的剂量分布提供理论依据,以期改善患者的预后和减少并发症的发生。方法:前瞻性收集2023年2月—2023年12月华北理工大学附属医院放疗科收治的行胸部放疗的恶性肿瘤患者。纳入标准:①经病理学检查证实为恶性肿瘤(肺癌、乳腺癌或食管癌)患者;②有放疗适应证;③美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分0~1分;④心电图、心脏彩超等检查无明显异常;⑤患者知情同意并签署同意书。排除标准:①曾接受过胸部放疗;②治疗前自觉明显心悸、胸闷和胸痛的患者;③合并糖尿病、心脏病等严重基础疾病;④目前正在使用抗心律失常药物;⑤不能耐受放疗以及随访过程中失访或脱失者。采用HRV分析评估放疗后自主神经功能的变化情况,将出现AD的患者纳入病例组,其余患者纳入对照组,采用单因素和多因素logistic回归分析方法探索胸部放疗后�Background and purpose:The incidence of autonomic dysfunction(AD)in patients with advanced cancer is approximately 65%-80%.The neurasthenic symptoms such as dizziness,palpitations and fatigue caused by AD are difficult to alleviate even with sufficient rest,seriously affecting the patients’quality of life.Meanwhile,the cardiovascular autonomic nervous system plays a significant regulatory role in heart rate,myocardial function and myocardial blood flow.AD increases the morbidity and mortality risk of cardiovascular diseases in patients.AD is not only a functional state but might also be an early sign of overall myocardial lesion.Research indicates that after adjusting for age,gender and cardiovascular risk factors,previous radiation exposure is associated with AD manifestations such as increased resting heart rate and abnormal heart rate recovery after exercise.However,there are currently few relevant studies on the effect of radiotherapy on cardiac autonomic function,and the specific injury effects and dose threshold of injury occurrence remain unclear.This study aimed to explore the impact of thoracic radiotherapy on the cardiac autonomic function of patients with malignant tumors by comparing the differences in heart rate variability(HRV)analysis parameters before and after radiotherapy,and to explore the dosimetric risk factors for the occurrence of AD by comparing the dosimetry between the case group and the control group,providing a theoretical basis for optimizing the dose distribution of radiotherapy regimens in order to improve patient prognosis and reduce the occurrence of complications.Methods:We prospectively collected data of patients with malignant tumors who underwent thoracic radiotherapy in the Radiotherapy Department of the Affiliated Hospital of North China University of Science and Technology from February 2023 to December 2023.Inclusion criteria:①Patients who were pathologically confirmed to have malignant tumors(lung cancer breast cancer or esophageal cancer);②patients with radiation t

关 键 词：胸部放疗 恶性肿瘤 心脏自主神经功能 心率变异性 心脏损伤 

分 类 号：R730.55[医药卫生—肿瘤]