三维放疗急性放射性心脏损伤类型及影响因素分析

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1、•胸部肿瘤・三维放疗急性放射性心脏损伤类型及影响因素分析王军王祎刘青程云杰曹峰龙书敬尚凯景绍武【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索。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RIHI)状况。分析其表现类型、展础心功能状况及相关临床、物理因索等对其发生的影响。用配对/检验行组间比较皿欣法行因索分析。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、左心室收缩功能滅低7例、肌钙蛋白I升高6例、心包积液3例。3

2、7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19J2例。单因索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(/=0~1.98,P=0.160~0.999)。多因素分析显示心脏是彩响急性RIHD发生的独立因素(£=5.10,P=0.024)o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Vg是影响急性RIHD发生的独立因素。【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Analysisofmanifestationsandinfluentialfactorsforacut

3、eradiation-inducedheartdamageafterthree-dimensionalradiotherapyWANGJim、WANGYi,LIUQing、CHENGYun-jie,CAOFeng,LONGShu-jing^SHANGKai,JINGShao-wu.DepartmentofRadiationOncology、FourthHospitalofHebeiMedicalUniversity,Shijiazhuang050011,China[Abstract]ObjectiveToinvestigatethemanifestat

4、ionsandinfluentialfactorsforacuteradiation-inducedheartdamage(KIHD)afterthree-dimensionalradiotherapyinpatientswiththoracicneoplasms.MethodsThree-dimensionalconfonnalradiotherapyorintensity-mcMhilatedradiotherapywasdeliveredto54patientswiththoracicneoplasms.ThestatusofacuteKIHDw

5、asevaluatedbyCommonTerminologyCriteriaforAdverseEventstVersion3・0.Theassociationsofmanifestations,basiccardiacfunction9andclinicalandphysicalfactorswithacuteKINDwereanalyzed・Apaired/-testwasusedforcomparisonbetweengroups；alogisticregressionanalysiswasusedforrnultivariateanduniva

6、riateanalysis.ResultsTheoverallincidencerateofacuteBIHI)was70%(38patients)9allofgrade1・Ofthe38a(vutcBIHI)palicn馆.37hadabnormalelectrocardiogram(ECG),7hadelevationofmy(x!ar(liulenzymest7haddecreaseinleftventricularsystolicfunctiont6hadcardiacIroponinIincreasetand3hadpericardialef

7、fusion.Ofthe37patientswithabnonnalECG.19hadST-scgmentchangestand12hadsinustachycardia.Noneofthebasiccardiacfunction,historyofsmoking9historyofchemotherapyfandhistoryofheartdiseasewasassociatedwithacuteRIHD(X’=0—1.981P=0.160—.999)taccordingtotheunivariateanalysis.Themultivariatea

8、nalysisrevealedthattherelativevolumeofthehearte