蒽环类抗生素导致儿童急性白血病化疗严重心脏毒性的临床分析

目的总结急性白血病患儿使用蒽环类抗生素化疗致严重心脏毒性的临床特征及预后。方法收集2003年1月至2009年3月血液病区发生的蒽环类抗生素相关严重心脏毒性的14例急性白血病患儿的临床资料，回顾分析其严重心脏毒性发生的时间、临床表现、实验室检查、治疗及转归。结果14例患儿心脏毒性发生时间为应用最近一次蒽环类抗生素后5—12d。蒽环类药物累积剂量为（以柔红霉素计）（134．8±56．6）mg／m^2。严重心脏毒性全部为亚急性，合并细菌感染13例。心电图均存在明显异常，超声心动图指标变化用药前后无显著差异（P〉0．05）。抢救成功10例。结论儿童急性白血病蒽环类抗生素化疗合并感染时严重心脏损害的发生率高，抢救成功病例恢复良好。

The clinical analysis of severe anthracycline-induced cardiotoxicity in children with acute leukemia

Objective To study the chnical feature and prognosis of severe anthracyeline-induced cardiotoxicity during chemotherapy in children with acute leukemia.Methods 14 cages with acute leukemia were diagnosed with severe anthracycline-induced cardiotoxicity in our hematopathy center during Jun 2003 to Mar 2009.The clinical data of these 14 cases were collected.The opportunity of the cardiac injury.the clinical feature,the laboratory results,and the post-treatment turnover of the patients were retrospectively analysed.Results The cardiotoxicity happened after the last anthracycline were given 5～12 days.The accumulated dose of marcellomycin was (calculated by daunomycin)(134.8±56.6)ms/m2.All of the cardiac injury were subacute.13 cases had bacterial infection.Being compared to the data prior of treatment,the cardiogram index of the failure heart had significant changes.while the data of the ultrasonic cardiogram had no significant changes (P＞0.05).10 cases were rescued successfully.Conclusion When children are infected during marcellomycin containing therapy,they may have hish incidence of the severe cardiac injury.However,those being rescued successfully recover well.