心率减速力检测在预测表阿霉素心脏毒性中的临床应用价值*

目的:探讨心率减速力（DC）在预测表阿霉素对恶性肿瘤患者心脏毒性中的价值。方法:回顾性分析广西医科大学附属肿瘤医院经病理确诊为恶性肿瘤并用含表阿霉素方案化疗的140 例患者临床资料，收集所有患者化疗前后CK-MB、cTnI 、动态心电图资料，根据计算出的DC值分为DC> 4.5 ms组和DC≤ 4.5 ms组，对比两组含表阿霉素方案患者化疗前、化疗2 、4 个周期后CK-MB、cTnI 水平及动态心电图平均心率、室上性及室性心律失常计数。结果:两组患者化疗前相关临床病理资料比较，差异无统计学意义（P > 0.05）；化疗4 个周期后DC≤ 4.5 ms组的血清CK-MB和cTn Ⅰ浓度与化疗前差值的均数高于DC> 4.5 ms组，差异有统计学意义（P < 0.05）；化疗2、4 个周期后DC≤ 4.5 ms组的平均心率、室上性心律失常及室性心律失常计数与化疗前差值的均数高于DC> 4.5 ms组，差异均有统计学意义（P < 0.05）；化疗后DC≤ 4.5 ms组中23例患者cTn Ⅰ异常升高，且cTn Ⅰ升高患者与cTn Ⅰ正常患者在化疗前CK-MB和cTn Ⅰ浓度、平均心率、室上性心律失常及室性心律失常比较，差异无统计学意义，而cTn Ⅰ升高患者的DC值明显低于cTn Ⅰ正常患者，差异有统计学意义（P < 0.05）。 结论:表阿霉素导致心脏毒性发生的风险随患者DC值下降而增加，化疗前检测DC值能较好地预测患者发生表阿霉素心脏毒性的风险。 

Clinical value of heart rate deceleration capacity test in predicting epirubicin-induced cardiotoxicity

Objective:To investigate the effectiveness of heart rate deceleration capacity (DC) measurement in predicting the car -diotoxicity of malignant tumor patients treated with epirubicin-based chemotherapy. Methods:The clinical medical records, including CK-MB and cTnI levels and dynamic electrocardiogram (ECG) parameters before and after each chemotherapy cycle, of 140 patients treated with epirubicin-based chemotherapy were analyzed. Patients were divided into the DC> 4.5 ms group and the DC≤ 4.5 ms group based on the calculated DC values. The CK-MB and cTnI levels and the dynamic ECG parameters of the two groups were compared af-ter two and four cycles of chemotherapy. Results:Patients in the two groups exhibited no statistically significant difference in their rele-vant clinical and pathological data before receiving chemotherapy ( P>0.05). However, after four cycles of chemotherapy, the DC≤ 4.5 ms group showed a significantly greater increase in serum CK-MB and cTnI concentrations over the pre-chemotherapy levels compared with the DC>4.5 ms group. After two and four cycles of chemotherapy, the DC≤ 4.5 ms group also exhibited a significantly greater in -crease in mean heart rate (beats/min) and supraventricular and ventricular arrhythmia counts (times/24h) over the pre- chemotherapy values compared with the DC> 4.5 ms group (P<0.05). After four cycles of chemotherapy, 23cases showed abnormally elevated cTnI levels in the DC ≤ 4.5 ms group. In this group, patients with elevated cTnI level exhibited no statistically significant difference in CK-MB and cTnI concentrations, mean heart rates, and supraventricular and ventricular arrhythmia counts compared with those with nor-mal cTnI level before chemotherapy (P>0.05). However, the DC values of patients with elevated cTnI were significantly lower than those with normal cTnI level (P<0.05). Conclusion:The risk of epirubicin-induced cardiotoxicity increased with decrease in DC value. The DC test was shown to be an effective predictor of the risk of epirubicin-induced cardiotoxicity.