摘要
目的研究胸部肿瘤放疗后急性放射性心脏损伤（RIHD）表现类型及其影响因素。方法接受三维放疗的胸部肿瘤患者54例，应用不良反应常见术语标准3．0版标准评价患者急性RIHD状况。分析其表现类型、基础心功能状况及相关临床、物理因素等对其发生的影响。用配对t检验行组问比较，Logistic法行因素分析。结果急性RIHD总发生率为70％（38例），均为1级损伤。38例急性RIHD中心电图异常37例、心肌酶升高7例、左心室收缩功能减低7例、肌钙蛋白I升高6例、心包积液3例。37例心电图异常的以ST段改变及窦性心动过速为主要表现，分别为19、12例。单因素分析未发现基础心功能状况、吸烟史、化疗史、心脏病史等与急性RIHD相关（X2=0～1．98，P=0．160～0．999）。多因素分析显示心脏V60是影响急性RIHD发生的独立因素（X2=5．10，P=0．024）。结论三维放疗较常规放疗急性RIHD发生程度减轻并以心电图异常最为常见，心脏V60是影响急性RIHD发生的独立因素。
Objective To investigate the manifestations and influential factors for acute radiation- induced heart damage （RIHD） after three-dimensional radiotherapy in patients with thoracic neoplasms. Methods Three-dimensional conformal radiotherapy or intensity-modulated radiotherapy was delivered to 54 patients with thoracic neoplasms. The status of acute RIHD was evaluated by Common Terminology Criteria for Adverse Events, Version 3.0. The associations of manifestations, basic cardiac function, and clinical and physical factors with acute RIHD were analyzed. A paired t-test was used for comparison between groups;a logistic regression analysis was used for multivariate and univariate analysis. Results The overall incidence rate of acute RIHD was 70% （38 patients） , all of grade 1. Of the 38 acute RIHD patients, 37 had abnormal electrocardiogram （ECG）, 7 had elevation of myocardial enzymes, 7 had decrease in left ventricular systolic function, 6 had cardiac troponin I increase, and 3 had pericardial effusion. Of the 37 patients with abnormal ECG, 19 had ST-segment changes, and 12 had sinus tachycardia. None of the basic cardiac function, history of smoking, history of chemotherapy, and history of heart disease was associated with acute RIHD （ X2 = 0 --1.98, P = 0. 160 --0. 999 ）, according to the univariate analysis. The multivariate analysis revealed that the relative volume of the heart exposed to 60 Gy irradiation （ V60 ） was the independent influential factor for acute RIHD （X2 = 5.10, P = 0. 024）. Conclusions Acute RIHD is less severe after three-dimensional radiotherapy than after conventional radiotherapy, and abnormal ECG is the most common. V60 of the heart is the independent influential factor for acute RIHD.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2013年第3期213-216,共4页
Chinese Journal of Radiation Oncology
关键词
放射性心脏损伤
损伤相关性
胸部肿瘤
三维放射疗法
Radiation-induced heart damage
Damage-related
Thoracic neoplasms/three dimensional radiotherapy
