儿童急性淋巴细胞白血病化疗期间的心电图表现及其影响因素  

Electrocardiographic manifestations and their influencing factors in children with acute lymphoblastic leukemia during chemotherapy

作　　者：位静波 刘春丽 周东民 WEI Jing-bo;LIU Chun-li;ZHOU Dong-min(ECG Room,Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008,Henan,CHINA;Department of Ultrasound Medicine,Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008,Henan,CHINA;Intensive Care Unit,Affiliated Cancer Hospital of Zhengzhou University(Henan Cancer Hospital),Zhengzhou 450008,Henan,CHINA)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)心电图室,河南郑州450008 [2]郑州大学附属肿瘤医院(河南省肿瘤医院)超声医学科,河南郑州450008 [3]郑州大学附属肿瘤医院(河南省肿瘤医院)重症医学科,河南郑州450008

出　　处：《海南医学》2025年第2期247-251,共5页Hainan Medical Journal

基　　金：二〇二四年河南省科技攻关项目(编号:242102310248)。

摘　　要：目的探讨儿童急性淋巴细胞白血病化疗期间的心电图表现及其影响因素。方法回顾性分析2023年1月1日至2024年6月30日在河南省肿瘤医院住院治疗的111例急性淋巴细胞白血病患儿的临床和心电图检查资料。在化疗前期、早期强化治疗期和缓解后巩固治疗期,分析患儿的心电图表现,包括窦性心动过缓、窦性心动过速、ST改变、ST-T改变、T波改变、Q-T间期延长、房性前期收缩和室性前期收缩指标变化;采用单因素和多因素Logistic回归分析法分析患儿化疗期间心电图参数变化的相关影响因素。结果缓解后巩固治疗期患儿窦性心动过速、ST改变、T波改变的发生率均高于化疗前期及早期强化治疗期的患儿,且早期强化治疗期患儿的上述各项指标高于化疗前期患儿,差异均有统计学意义(P<0.05)。缓解后巩固治疗期及早期强化治疗期患儿的ST-T改变、Q-T间期延长、房性前期收缩及室性前期收缩发生率明显低于化疗前期患儿,差异均有统计学意义(P<0.05),但缓解后巩固治疗期与早期强化治疗期患儿的上述各项指标比较差异均无统计学意义(P>0.05)。单因素分析结果显示,疾病危险度为中危的患儿心电图参数异常率明显低于疾病危险度为高危的患儿,化疗后患儿的心电图参数异常率明显高于化疗前患儿,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,疾病危险程度及化疗时间是心电图参数出现异常的独立危险因素(P<0.05)。结论急性淋巴细胞白血病患儿治疗前后心电图异常存在,且异常的发生与患儿疾病危险度及化疗时间有关,需通过心电图严密检测分析心脏损伤情况以及时有效的措施降低心脏毒性,以确保化疗效果最大化。Objective To explore the electrocardiographic manifestations and their influencing factors in children with acute lymphoblastic leukemia during chemotherapy.Methods The clinical and electrocardiographic data of 111 children with acute lymphoblastic leukemia hospitalized in Henan Cancer Hospital from January 1,2023 to June 30,2024 were retrospectively analyzed.During the pre-chemotherapy phase,early intensive treatment phase,and post-remission consolidation treatment phase,the electrocardiographic manifestations of the children were analyzed,including sinus bradycardia,sinus tachycardia,ST changes,ST-T changes,T wave changes,Q-T interval prolongation,and changes in atrial premature contraction and ventricular premature contraction indexes.Univariate and multivariate logistic regression analysis were used to analyze the related influencing factors of electrocardiogram(ECG)parameters during chemotherapy.Results The incidence of sinus tachycardia,ST changes,and T wave changes in children in the post-remission consolidation treatment phase were higher than those in the pre-chemotherapy phase and early intensive treatment phase,and the above indicators of children in the early intensive treatment phase were higher than those in the pre-chemotherapy phase,with statistically significant differences(P<0.05).The incidence of ST-T changes,QT interval prolongation,atrial premature contraction,and ventricular premature contraction in children in the post-remission consolidation treatment phase and early intensive treatment phase were significantly lower than those in the pre-chemotherapy phase(P<0.05),but there was no statistically significant difference in the above indicators between the children in the post-remission consolidation treatment phase and the early intensive treatment phase(P>0.05).Univariate analysis showed that the abnormal rate of ECG parameters in children with moderate disease risk was significantly lower than that in children with high disease risk,and the abnormal rate of ECG parameters in children after

关 键 词：儿童 急性淋巴细胞白血病 化疗 心电图 心脏毒性 

分 类 号：R729[医药卫生—儿科]