淋巴瘤患者血浆脑钠肽与蒽环类药物心脏毒性的相关性研究

 目的 探讨淋巴瘤患者血浆中脑钠肽(BNP)与蒽环类药物心脏毒性的相关性。方法 选择使用蒽环类药物化疗后的36例淋巴瘤患者,分别在化疗前及蒽环类药物累积量达200、400mg/m2后,检测血浆脑钠肽及超声心动图各指标变化情况。结果 当蒽环类药物累积量达到200 、400mg/m2时,36例淋巴瘤患者血浆BNP水平为(292±6.71) ng/ml、（387±3.54）ng/ml较化疗前(134±5.87) ng/ml明显升高（P<0.05）,心室舒张功能指标（左室舒张期/收缩期充盈峰速度E/A）为1.14±0.37、0.90±0.06较化疗前1.33±0.27明显降低(P<0.05),而收缩功能指标（射血分数EF、短轴缩短率FS）差异无统计学意义(P>0.05)。当蒽环类药物累积量达到200、400mg/m2时,血浆BNP水平与E/A存在负相关(r值-0.689,p值0.042;r值-0.557,p值0.006）,而与EF、FS不存在相关性(P>0.05)。结论 BNP作为蒽环类药物化疗心脏毒性的早期监测指标有一定临床意义。     

二维斑点追踪成像技术结合心肌做功评价蒽环类药物对乳腺癌患者左心室功能的影响#br#

背景与目的：应用二维斑点追踪成像（two-dimensional speckle tracking imaging,2D-STI）结合心肌做功评价蒽环类药物对乳腺癌患者左心室功能的影响。方法：前瞻性选择2019年9月—2020年3月在复旦大学附属肿瘤医院行蒽环类药物治疗的35例乳腺癌患者,分别于化疗前、化疗2个周期后、4个周期后行常规超声心动图检查并获取动态二维图像,同时使用肱动脉袖带血压计测量患者收缩期及舒张期血压值,测量左房内径（left atrial diameter,LAD）、左心室舒张末期内径（left ventricular end-diastolic diameter,LVEDD）、左心室收缩末期内径（left ventricular end-systolic diameter,LVESD）、舒张末期室间隔厚度（diastolic interventricular septal depth,IVSD）、左心室舒张末期容积（left ventricular end-diastolic volume,LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume,LVESV）、左心室射血分数（left ventricular ejection fraction,LVEF）、二尖瓣口舒张早期峰值流速（early diastolic peak velocity,E峰）、舒张晚期峰值流速（late diastolic tissue velocity,A峰）、二尖瓣环间隔处舒张早期峰值速度（early diastolic tissue velocity,e’）,并计算E/A、E/e’;应用EchoPac软件脱机分析,获取左心室整体纵向应变（global longitudinal strain,GLS）、左心室分层纵向应变（GLSendo、GLSmid、GLSepi）,以及左心室心肌整体做功指数（global myocardial work index,GWI）、整体有用功（global constructive work,GCW）、整体无用功（global wasted work,GWW）、整体做功效率（global myocardial work efficiency,GWE）;并行统计学分析。结果：与化疗前比较,化疗2个周期乳腺癌患者GLSeondo、GLS有所减低,但差异无统计学意义（P＞0.05）;GWW增加,GWE降低（P＜0.05）;化疗4个周期后GLS、GLSendo、GWI、GCW、GWE均降低,GWW增加。与化疗2个周期后比较,化疗4个周期后乳腺癌患者GLS、GLSendo、GWI、GCW、GWE降低,GWW增加（P＜0.05）。与化疗前比较,化疗4个周期后乳腺癌患者E/e’升高（P＜0.05）。各周期结束后的其余各项超声心动图参数与化疗前比较差异均无统计学意义（P＞0.05）。结论：2D-STI能早期检测乳腺癌患者在蒽环类药物化疗中左心室功能的早期改变, GWW及GWE较其他参数更敏感。     

应变率成像技术评价以表阿霉素为主的化疗方案对乳腺癌患者左心功能影响的研究

目的：探讨应变和应变率成像技术在评价表阿霉素致乳腺癌患者左心功能影响中的优势。方法：选择经病理确诊的女性乳腺癌患者78例。均采用FEC方案化疗。采用自身对照研究对乳腺癌患者6个化疗周期进行观察,分别于化疗前1天及每周期化疗后第5天行心电图、心肌酶学、常规超声心动图及应变率成像检测。SPSS13.0统计软件进行统计分析。结果：随表阿霉素累积量增加,于第4、5周期时心电图异常率增加,第6周期时,心电图异常率明显增加,与化疗前比较,差异有统计学意义（P〈0.05）;第6周期时出现心肌酶增高（P〈0.05）;第6周期时左室射血分数（LVEF）及E/A减低（P〈0.05）;应变率成像结果显示：随表阿霉素累积量的增加,于第4周期时舒张早期峰值应变率（SRe）、房缩期峰值应变率（SRa）减低（P〈0.05）,第5周期时SRe、SRa明显减低（P〈0.01）,第6周期时,出现下壁及前壁的SRs减低（P〈0.05）,后间隔、侧壁、前间隔及后壁的SRs明显减低（P〈0.01）。结论：乳腺癌患者化疗过程中,随表阿霉素累计量的增加,心电图和应变率成像较早出现异常,而心肌酶和常规超声心动图指标则较晚出现异常。应变率成像能够早期较精确的反映表阿霉素致乳腺癌患者左心功能的影响。     

二维与三维超声心动图斑点追踪技术检测乳腺癌蒽环类药物心脏毒性的可行性研究

目的:探讨二维与三维斑点追踪技术以及实时三维超声心动图在早期检测蒽环类药物所致心脏毒性中的价值,并评估其可行性.方法:对乳腺癌患者于蒽环类药物化疗前、化疗第3周期及化疗结束后行超声心动图检查,以3D LVEF结果为评价标准,统计分析各参数在评估心脏毒性中的临床价值.结果:共92例乳腺癌患者纳入研究.常规超声心动图以及2...     

GDF-15及三维斑点追踪技术对应用蒽环类药物的乳腺癌患者出现早期心脏毒性的预测价值

目的 探讨GDF-15及三维斑点追踪技术对应用蒽环类药物的乳腺癌患者出现早期心脏毒性的预测价值。方法 收集乳腺癌患者60例,均接受EC/AC-D联合化疗方案。分别于化疗前、化疗2周期、化疗4周期后对患者进行超声及血液检查。结果 与化疗前超声心动图指标相比,化疗2周期及4周期后患者左室ESV、EDV、LVEF、E/A及SV均无明显差异(P>0.05)。与化疗前应变参数相比,化疗2周期及4周期后患者GLS及GAS均下降(P<0.05),而GCS、GRS变化不明显(P>0.05)。与化疗前相比,化疗2、4周期后患者血液相关指标均显著升高(P<0.05)。多因素Logistic回归分析表明仅有GDF-15、cTnl及GLS为乳腺癌患者行蒽环类药物治疗出现心脏毒性的独立预测因素(P<0.05)。结论 GDF-15及三维斑点追踪技术在评估蒽环类药物对乳腺癌患者心脏毒性的预测方面有较高的应用价值,可作为早期监测其心脏毒性的可靠方法。     

乳腺癌患者术后化疗所致早期心脏毒性监测指标的研究

目的：观察乳腺癌术后辅助化疗患者的早期心脏毒性监测指标（左室射血分数、心肌做功指数、心电图以及心肌钙蛋白）的变化,评价其敏感性及临床意义。方法：选取42例乳腺癌患者,随机分为两组：干预组21例,患者接受TAC（多西紫杉醇＋吡喃阿霉素＋环磷酰胺）方案加右丙亚胺（右丙亚胺对吡喃阿霉素比值为10：1）;化疗组21例,常规接受TAC方案加安慰剂治疗。采用重复测量设计资料的方差分析化疗前、化疗后每周期以及化疗结束后3个月的心脏毒性指标变化情况。结果：两组患者不同周期左室射血分数（LVEF）变化无统计学意义（P〉0.05）;心肌做功（Tel）指数随着化疗周期的增加其测量结果存在统计学差异（P〈0.05）,且干预组患者Tel指数明显低于化疗组（P〈0.05）;两组患者心电图检查主要表现为一过性改变,均未出现明显特异性改变;在未达到吡喃阿霉素最大累积量前,血清中心肌钙蛋白（cTnI）与体内吡喃阿霉素累积量呈现零相关性（P〉0.05）。结论：蒽环类药物从第一次应用时对心脏就产生了明显的毒性,使用右丙亚胺对蒽环类药物所致心脏毒性有一定的防护作用。对两组患者心脏彩超、LVEF、心电图、cTnI等检查研究发现,上述指标对评价蒽环类药物所造成的亚临床左室结构与功能异常方面的敏感性与特异性较差,在临床上并不能及早有效评估化疗后患者早期心脏毒性,而Tel指数较之传统心脏超声、心电图、cTnI等能够更早、更敏感地评价蒽环类化疗药物对化疗患者心脏早期毒性。     

蒽环类药物累积剂量与血清心肌肌钙蛋白T水平关系的研究

 目的　研究蒽环类药物累积剂量与血清心肌肌钙蛋白T（cTnT）水平的关系。方法　回顾性分析2004年1月至2009年1月应用蒽环类药物化疗的88例急性白血病患者cTnT水平及其蒽环类药物累积剂量,以某一累积剂量水平分组计算各组cTnT升高的发生率。结果　蒽环类药物累积剂量＜200 mg／m2组51例,1例 cTnT水平升高,蒽环类药物累积剂量≥200 mg／m2组37例,　8例cTnT水平升高,两组cTnT升高的发生率差异有统计学意义（P＜0.05）。结论　蒽环类药物达到一定剂量时,cTnT升高发生率明显升高。     

超声二维斑点追踪技术监测蒽环类药物治疗恶性淋巴瘤后心脏功能变化

摘 要：［目的］ 探讨超声二维斑点追踪成像（2D-STI）技术在监测恶性淋巴瘤蒽环类药物（ANTH）化疗后心脏功能变化及评价ANTH亚临床期心脏毒性方面的价值。［方法］ 选择初发确诊非霍奇金淋巴瘤（NHL）住院患者42例。所有患者均具有化学治疗指征,采用标准CHOP方案化疗。应用2D-STI技术,于化疗前、化疗第2、4、6个疗程后,即阿霉素累积剂量为100mg/m2、200mg/m2、300mg/m2后,采集心脏整体纵向应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）及左室扭转角度（LVtw）参数,进行化疗前后不同疗程比较;同时也对患者治疗前及治疗后不同疗程常规超声心动图的左室射血分数（LVEF）、E峰与A峰的比值（E/A）、E/e’和心肌做功指数（Tei指数）的变化进行对比分析。［结果］ GLS在化疗第2疗程后、第4疗程后和第6疗程后均较化疗前明显降低（分别为P=0.002,P<0.001,P<0.001）。而GRS、GCS在第6疗程后出现明显下降（分别为P<0.001、P=0.008）。化疗第4疗程、第6疗程后,LVtw比化疗前明显降低（P值均<0.001）。Pearson相关分析显示GLS、LVtw与阿霉素的累积剂量呈负相关。常规超声心动图LVEF、E/A、E/e’和Tei指数在化疗前后不同疗程改变不明显。［结论］ 2D-STI技术可以早期发现NHL患者ANTH化疗后心脏功能变化,可用于监测NHL患者ANTH化疗后亚临床期心脏功能减退。GLS和LVtw可以作为评价ANTH亚临床心脏功能减退的敏感参数。GLS和LVtw的减低与ANTH累积剂量呈负相关。     

右丙亚胺对复发平滑肌肉瘤患者化疗的心脏保护作用研究

目的：观察右丙亚胺（dexrazoxane,DEX）对平滑肌肉瘤复发患者接受蒽环类药物辅助化疗所致心脏毒副反应的保护作用.方法：将29例复发平滑肌肉瘤患者随机分成治疗组（DEX组）和对照组.两组患者均接受以蒽环类药物为基础的辅助化疗5个周期,治疗组在使用蒽环类药物化疗的基础上加用右丙亚胺（右丙亚胺∶表柔比星=10∶1）,在第一次应用蒽环类药物时即给予右丙亚胺.监测各时期心肌肌钙蛋白（cTnT）和左心室射血分数（LEVF）,统计临床心功能不全的发生率以进行心脏功能评估,同时观察治疗的非心脏毒副反应及疗效.结果：两组患者在年龄、体重、ECOG评分等方面没有统计学差异（P＞0.05）.从表柔比星（EPI）治疗的第一个周期开始cTnT明显上升,到治疗结束时达到最高,直到治疗后2年仍然维持在较高水平.加用DEX组（即治疗组）在治疗期间及治疗后cTnT水平都较低,两组比较差异有显著性（P＜0.05）.而LEVF在两组的各个治疗阶段水平都没有统计学差异（P＞0.05）.两组的非心脏毒副反应没有差异.结论：EPI从第一次应用时对心脏便产生了明显的毒副反应,加用DEX后可以降低这种心脏毒副反应.     

右丙亚胺联合参麦注射液降低蒽环类药物心脏毒性的临床研究

  目的  比较右丙亚胺单用、参麦注射液单用, 或者联合使用参麦注射液和右丙亚胺对血液系统肿瘤患者蒽环类药物多疗程化疗所致心脏不良反应的临床意义, 进一步探讨降低蒽环类药物心脏毒性的途径。  方法  本研究入组120例血液系统肿瘤患者, 共分为4组, 每组30例。A组为参麦组, 在化疗基础上单用参麦注射液, 50 mL/d连用lw; B组为联合使用参麦注射液和右丙亚胺, 在应用蒽环类药物化疗前30 min快速静脉滴入右丙亚胺及阿霉素（剂量10:1）, 非阿霉素蒽环类药物折合成阿霉素。且在化疗开始之日起, 予以参麦注射液50 mL/d, 连用1w;C组为右丙亚胺组, 应用蒽环类药物化疗前30 min予右丙亚胺及阿霉素快速静脉滴入; A、B、C 3组为实验组, D组为空白对照组, 予以常规化疗; 4组患者均按要求完成2个化疗周期, 观察化疗前后4组患者的心电图改变以及超声心动图（左室射血分数LVEF）, B型利钠肽（BNP）, 肌钙蛋白I（TnI）的数值变化。  结果  通过比较化疗前后4组患者的心电图变化和左室射血分数（LVEF）、肌钙蛋白I（TnI）、B型利钠肽（BNP）的数值变化, 实验组心电图异常的发生率、LVEF下降百分比、TnI和BNP的数值升高均小于空白对照组（P < 0.05）。  结论  右丙亚胺、参麦注射液单用以及二者合用, 降低血液系统恶性肿瘤患者接受蒽环类药物多疗程化疗所致心脏毒性, 均有一定疗效, 其中右丙亚胺及参麦注射液联合疗效最佳, 而右丙亚胺单用对心肌细胞保护作用好于参麦注射液单用。在蒽环类药物化疗同时配伍使用参麦注射液及右丙亚胺, 可减低心脏毒性, 值得临床推广应用。      

cTnT can be a useful marker for early detection of anthracycline cardiotoxicity.

BACKGROUND: The level of serum cardiac troponin-T (cTnT) increases with myocardial damage. We sought to assess whether cTnT level could be a useful marker for the early detection of anthracycline cardiotoxicity. PATIENTS AND METHODS: Forty-one patients who had been scheduled to receive anthracycline-containing combination chemotherapy were included in the study. Serum cTnT levels were measured before (baseline) and after the first cycle of chemotherapy, and again, after the last cycle of chemotherapy. In all patients, the left ventricular ejection fraction (LVEF), fractional shortening (FS), early peak flow/atrial flow velocity (E/A) ratio, and the isovolemic relaxation time (IRT) were measured echocardiographically, both before and after the completion of chemotherapy. RESULTS: LVEF and FS did not change in any patients. In 21 patients (49%), the E/A ratio decreased after therapy as compared to the pre-treatment values. The decrease in E/A ratio was more prominent in patients who were older than the mean age of our study group, which was 44 years. The post-treatment IRT was prolonged compared with the pretreatment IRT (94.0 +/- 2.0 versus 85.6 +/- 10.5 ms, respectively). cTnT levels after completion of therapy were elevated in 14 (34%) patients, and exceeded the upper limit of the normal range (>0.1 ng/ml) in only one patient. cTnT levels measured after completion of therapy were significantly higher, compared with those measured at baseline and after the first cycle of therapy. In the younger age group (< or =44 years old), there was a two-fold decrease in the E/A ratio in those patients whose cTnT levels increased during the therapy, when compared with those whose cTnT levels did not change (21% versus 43%, respectively). CONCLUSION: Increased serum cTnT level can be detected in the early stages of anthracycline therapy and it is associated with diastolic dysfunction of the left ventricle. Therefore, serum cTnT level could be a useful measure for early detection of anthracycline-induced cardiotoxicity.     

缺血修饰白蛋白检测对多柔比星心肌毒性诊断价值的探讨

目的:探讨缺血修饰白蛋白(IMA)对多柔比星导致急性心肌毒性反应早期诊断的临床意义,对多柔比星导致急性心肌毒性反应患者作出早期诊断及预测.方法:根据临床表现、心电图、患者IMA和肌钙蛋白T(cTnT)血清结果,将106例用多柔比星治疗的患者血清分为发病人群发病时血清(A组)、发病人群给药24 h后血清(B组)、高危人群给药24 h后血清(C组)及未发病人群给药24 h后血清(D组)4组血清,对4组中的血液指标检验结果升高例数进行组内及组间x2检验,比较其中差异；并对106例多柔比星诱发的急性心肌毒性患者的515份心电图与515份血清中的IMA指标升高例数进行相关性分析.结果:多柔比星急性心肌毒性反应患者发病时血清与正常人群血清IMA升高例数差异有统计学意义,x2 =30.94,P=0.00.多柔比星心肌毒性反应患者在用药24 h后与正常人群血清中IMA及cTnT升高例数差异有统计学意义(x2=36.43,P=0.00;x2=128.23,P=0.00).106例患者的515份异常心电图与515份血清中的IMA值异常例数进行相关性分析,结果提示发生急性心肌毒性反应患者中IMA的升高与心电图之间存在着相关性,r=0.783,P＜0.05.结论:多柔比星急性心肌毒性反应患者的IMA血液检验指标的异常提示,IMA检测对诊断多柔比星心肌毒性反应存在一定价值.     

Correlation between serum levels of cardiac troponin-T and the severity of the chronic cardiomyopathy induced by doxorubicin.

PURPOSE: To investigate, over a wide range of cumulative doxorubicin doses, the feasibility of using serum concentrations of cardiac troponin-T (cTnT) as a biomarker for doxorubicin-induced myocardial damage. MATERIALS AND METHODS: Groups of spontaneously hypertensive rats (SHR) were given 1 mg/kg doxorubicin weekly for 2 to 12 weeks. Cardiomyopathy scores were assessed according to the method of Billingham and serum levels of cTnT were quantified by a noncompetitive immunoassay. Myocardial localization of cTnT was studied by immunohistochemical staining and confocal microscopy. RESULTS: Increases in serum levels of cTnT (0.03 to 0.05 ng/mL) and myocardial lesions (cardiomyopathy scores of 1 or 1.5) were found in one out of five and two out of five SHR given 2 and 4 mg/kg doxorubicin, respectively. All animals given 6 mg/kg or more of doxorubicin had increases in serum cTnT and myocardial lesions. The average cTnT levels and the cardiomyopathy scores correlated with the cumulative dose of doxorubicin (0.13 v 0.4 ng/mL cTnT and scores of 1.4 v 3.0 in SHR given 6 and 12 mg/kg doxorubicin, respectively). Decreased staining for cTnT was observed in cardiac tissue from SHR receiving cumulative doses that caused only minimal histologic alterations (scores of 1 to 1.5). Staining for cTnT decreased simultaneously with increases in the severity of the cardiomyopathy scores. CONCLUSION: cTnT is released from doxorubicin-damaged myocytes. Measurements of serum levels of this protein seem to provide a sensitive means for assessing the early cardiotoxicity of doxorubicin.     

脑肿瘤与脑血管意外心电图改变的对比观察

 目的　探讨脑肿瘤与脑血管意外部位与心电图改变的相关性。方法　对 85例脑肿瘤与 87例脑血管意外行头颅CT扫描及心电图检查 ,并作对比性分析。结果　脑肿瘤、脑出血 (CH)、脑梗塞 (CI)心电图异常发生率分别为 6 0 %、82 .35 %、73.5 8% ,三组之间有显著性差异 (P <0 .0 5 )。脑肿瘤心电图改变以顶叶发生率为高 ,达 2 9.4 1% ,而脑出血、脑梗塞以基底节发生率最高 ,分别为 38.2 4 %、6 6 .0 4 % ,统计学处理差异显著 (P <0 .0 5 )。结论　心电图异常改变既与病变性质有关 ,也与脑损害部位有关 ,越靠近中线部位的病变 ,心电图异常发生率越高且越严重     

Cardiac troponin T as an indicator of reduced left ventricular contractility in experimental anthracycline-induced cardiomyopathy

Purpose Cardiac troponin T (cTnT) plasma concentration is considered a useful marker of anthracycline-induced cardiomyopathy. In this study we used daunorubicin-treated Chinchilla rabbits as a model to investigate the relationship between left ventricular contractility and cTnT plasma concentrations.Methods Two groups of animals were used: a control group (n=8) received i.v. saline, and an experimental group (n=11) received daunorubicin (3 mg/kg, i.v.). The substances were administered once weekly for 10 weeks, and 5–7 days after the last administration, left ventricular cardiac contractility (dP/dt_max) was invasively measured as a contractility index and blood was sampled for cTnT concentration determination (Elecsys Troponin T STAT immunoassay).Results Cardiac contractility was significantly lower in seven surviving daunorubicin-treated animals than in control animals (745.7±69.3 vs 1393.4±25.5 kPa/s; P<0.001), while cTnT plasma concentrations were significantly increased (medians 0.278 vs 0.000 ng/ml; P<0.001). When the dP/dt_max values of individual daunorubicin-treated animals were plotted against the corresponding cTnT plasma concentrations, a close negative linear correlation was found (R=–0.910; P<0.005; regression equation: dP/dt_max=–1861*cTnT+1234).Conclusions This study suggests that determination of cTnT plasma levels, which is simple and inexpensive, could be used in anthracycline-treated patients for left ventricular systolic function assessment and contractility estimation.     

Are Biomarkers Predictive of Anthracycline-Induced Cardiac Dysfunction?

Background: The early detection of anthracycline- induced cardiotoxicity is very important since it might be useful in prevention of cardiac decompensation. This study was designed with the intent of assessing the usefulness of cardiac troponin T (cTnT) and NT- Pro BNP estimation in early prediction of anthracycline induced cardiotoxicity. Materials and Methods: In this prospective study histologically proven breast cancer patients who were scheduled to receive anthracycline containing combination chemotherapy as a part of multimodality treatment were enrolled. Baseline cardiac evaluation was performed by echocardiography (ECHO) and biomarkers like cardiac troponin T (cTnT) and N terminal- pro brain natriuretic peptide (NT- Pro BNP). All patients underwent cTnT and NT- Pro BNP estimation within 24 hours of each cycle of chemotherapy and were followed up after 6 months of initiation of chemotherapy. Any changes in follow up ECHO were compared to ECHO at baseline and cTnT and NT- Pro BNP levels after each cycle of anthracycline-based chemotherapy. Results: Initial data were obtained for 33 patients. Mean change in left ventricular diastolic diameter (LVDD) within 6 months was 0.154 0 .433 cms (p value=0.049). Seven out of 33 patients had an increase in biomarker cTnT levels (p value=0.5). A significant change in baseline and follow up LVDD was observed in patients with raised cTnT levels (p value=0.026) whereas no change was seen in ejection fraction (EF) and left atrial diameters (LAD) within 6 months of chemotherapy. NT- Pro BNP levels increased in significant number of patients (p value 0.0001) but no statistically significant change was observed in the ECHO parameters within 6 months. Conclusions: Functional monitoring is a poorly effective method in early estimation of anthracycline induced cardiac dysfunction. Estimation of biomarkers after chemotherapy may allow stratification of patients in various risk groups, thereby opening window for interventional strategies in order to prevent permanent damage to the myocardium.     

cTnT早期诊断蒽环类药物心脏毒性的实验研究

目的:研究血清肌钙蛋白T(cT-nT)浓度是否可以成为蒽环类药物心脏毒性早期诊断指标。方法:新西兰雄性兔44只,随机分为对照组(8只)和实验组(36只)。对照组新西兰兔注射等体积的生理盐水;实验组新西兰兔静脉注射多柔比星2 mg/(kg.次),1次/周,根据实验周数不同,实验组分为1周组(8只)、2周组(8只)、4周组(9只)和8周组(11只)。经胸超声心动图测量左室射血分数(LVEF)和左室短轴缩短分数(FS)以及E峰和A峰比值。血清GPBB浓度测量采用ELISA方法。心肌光镜Billingham评分和电镜检查评价多柔比星心脏毒性。结果:8周组新西兰兔LVEF、FS和E/A值均下降,P<0.05。与对照组相比,4周组新西兰兔血清cTnT浓度明显升高,P<0.05;8周组新西兰兔血清cTnT浓度显著高于其他组,P<0.05。光镜下4周组新西兰兔心肌损害比对照组严重,P<0.05;8周组新西兰兔心肌损害最严重,P<0.05。电镜下线粒体水肿和断裂可见于2周组、4周组和8周组,心肌损伤程度与多柔比星累积剂量有关。相关分析提示,血清cTnT浓度与多柔比星累积剂量(r=0.887,P<0.001)及血清cTnT浓度与...     

Troponin T in the first 24 hours after the administration of chemotherapy and the detection of myocardial damage in children

Early detection of damage to cardiac myocytes after cardiotoxic chemotherapy in paediatric patients may allow timely preventive measures to be taken. We investigated the diagnostic value of cardiac troponin T (cTnT) after the administration of cardiotoxic chemotherapy. In 38 children, cTnT levels were measured at three time points during the first 24 h after 58 cardiotoxic chemotherapy cycles (163 samples). An abnormal cTnT level, defined as a cTnT>0.010 ng/ml, was measured in only six samples from 3 patients. After completion of chemotherapy, 7 out of the 38 patients had left ventricular dysfunction (LV dysfunction). Only 1 of these 7 patients had an elevated cTnT level. 2 other patients with elevated cTnT levels did not develop LV dysfunction until 2 and 7 months after the cTnT measurement. Our data show that the measurement of cTnT within 24 h after administration of chemotherapy does not have a high sensitivity for the identification of patients with subsequent subclinical cardiotoxicity.     

多柔比星导致急性心肌毒性24小时内血清中缺血修饰白蛋白变化的临床观察

目的：通过临床观察IMA（缺血修饰白蛋白）诊断DOX（多柔比星）心肌毒性的敏感性、准确性以及是否存在早期诊断价值。方法：选取2007年7月至2014年7月住院使用DOX肿瘤化疗患者48例,在化疗前均常规查心电图、心脏彩超、cTnT（肌钙蛋白）,如以上指标有异常则不选用多柔比星化疗。在用DOX化疗期间如出现DOX导致的急性心肌毒性反应则将此患者定为入组条件。入组患者均在出现多柔比星导致的急性心肌毒性反应10分钟及3、6、12、24小时抽血查IMA、cTnT、CK－MB（心肌酶谱）检验指标。结果：在DOX导致的急性心肌毒性患者血清IMA值出现了变化,而这种变化在发生DOX急性心肌毒性早期就开始增高,各种对比P＜0．01,并且IMA的变化与心电图具有相关性（P＝0．000）。结论：IMA成为DOX心肌毒性反应的早期诊断指标具有一定价值。