Effect of radiotherapy on cardiac function after radical operation of left breast cancer
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摘要:
目的 比较左乳腺癌根治术后患者放疗前、中、后不同时期血清肌钙蛋白及心脏收缩舒张功能变化，分析放疗对心功能的影响。观察左卡尼汀对左侧乳腺癌根治术后放疗致心脏毒性的预防作用。 方法 随机入组70例左乳腺癌根治术后放疗患者。治疗组35例，对照组35例。治疗组在放疗治疗中予左卡尼汀1~2 g/d静滴，对照组不予使用保护心肌药物。所有患者均行同侧锁骨上下区及胸壁调强放疗：2 Gy/（次·d），5 d/周，5周。所有放疗病人均于放疗前、放疗2周、放疗结束、放疗结束后4周进行肌钙蛋白T检测及超声检查心脏收缩舒张功能。比较放疗前后肌钙蛋白T、心脏收缩舒张功能变化及两组差异。 结果 开始放疗后cTnT显著高于放疗前（F=292.548，P=0.000）；治疗组对cTnT保护效应优于对照组（F=88.960，P=0.000）。左心房收缩末期内径、左心室舒张末期内径、射血分数、短轴缩短率、二尖瓣舒张早期峰值流速、心房收缩期峰值流速、二尖瓣舒张早期峰值流速/心房收缩期峰值流速、二尖瓣瓣环室间隔侧收缩期峰值速度、二尖瓣瓣环室外侧的收缩期峰值速度、舒张早期峰值速度、舒张晚期运动速度、舒张早期峰值速度/舒张晚期运动速度在放疗后均低于放疗前（P<0.05）；治疗组和对照组在左心房收缩末期内径、二尖瓣舒张早期峰值流速、心房收缩期峰值流速、二尖瓣舒张早期峰值流速/心房收缩期峰值流速、二尖瓣瓣环室外侧的收缩期峰值速度、舒张早期峰值速度、舒张晚期运动速度、舒张早期峰值速度/舒张晚期运动速度差异无统计学意义（P>0.05）。治疗组对于心脏收缩舒张指标左心室舒张末期内径、射血分数、短轴缩短率、二尖瓣瓣环室间隔侧收缩期峰值速度保护效应优于对照组（P<0.05）。 结论 左乳癌术后放疗后心功能明显受损，放疗期间联合应用左卡尼汀保护心肌可以有效预防左侧乳腺癌根治术后放疗致心脏毒性。 Abstract:Objective To compare the changes of serum troponin and systolic and diastolic function in patients with left breast cancer before and after radiotherapy,analyze the effect of radiotherapy on cardiac function, and observe the preventive effect of levocarnitine on cardiac toxicity induced by radiotherapy after left radical mastectomy. Methods Seventy patients with left breast cancer underwent radiotherapy after radical surgery were randomly assigned with treatment group of 35 cases and control group of 35 cases. The treatment group in the radiotherapy treatment was performed with levocarnitine of 1-2 g/d intravenous infusion. The control group was not treated with myocardial protective drugs. All patients underwent ipsilateral supraclavicular region and chest wall intensity modulated radiotherapy: 2 Gy/(times· d), 5 d/week, 5 weeks. All radiotherapy patients were examined for troponin T detection, ultrasound examination of cardiac systolic and diastolic function before radiotherapy, radiotherapy for 2 weeks, the end of radiotherapy, 4 weeks after radiotherapy. Troponin T, diastolic and diastolic function of the two groups before and after radiotherapy were compared. Results CTnT after radiotherapy was significantly higher than that before radiotherapy (F=292.548, P=0.000). The protective effect of cTnT on the treatment group was better than that of the control group (F=88.960, P=0.000). Left atrial contraction end diameter (LADs), Left ventricular end diastolic diameter (LVDd), ejection fraction (EF), short axis shortening (FS), early mitral valve diastolic peak velocity (E), atrial systolic peak velocity (A), E/A, mitral annulus ventricular septal systolic peak velocity (Sa), systolic peak velocity (Sa), early diastolic peak velocity (Ea), diastolic velocity (Aa), Ea/Aa after radiotherapy were significantly lower than that before radiotherapy. There was no significant difference of LADS, E, A, E/A, Saoutside, Ea, Aa, Ea/Aa between the treatment group and the control group (P>0.05). The protective effect of LVDd, EF, FS and Sainterval side on the systolic and diastolic index of the treatment group was better than that of the control group (P<0.05). Conclusion Cardiac function of left breast cancer is significantly impaired after radiotherapy. Radiotherapy combined with application of levocarnitine during the radiotherapy can effectively prevent cardiac toxicity induced by radiotherapy after radical surgery. -
Key words:
- breast cancer /
- radiotherapy /
- cardiac function /
- levocarnitine
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表 1 两组临床资料比较（n）
项目 治疗组 对照组 χ2 P 年龄（岁） 0.8 0.67 <50 19 16 50 ~ 60 13 14 ≥60 3 5 T分期 1.076 0.584 1 1 2 2 14 17 3 20 16 4 0 0 N分期 0.939 0.816 0 4 2 1 6 7 2 18 20 3 7 6 M分期 0 35 35 1 0 0 AJCC分期 0.23 0.631 2 20 18 3 15 17 
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表 2 治疗组和对照组cTnT的比较（
$\, \overline{{x}}{{±}}{{s}}$ ）分组 放疗前 放疗2周 放疗结束 放疗结束后4周 治疗组 0.06±0.01 0.09±0.01 0.08±0.01 0.07±0.01 对照组 0.06±0.01 0.1±0.02 0.14±0.02 0.11±0.02 时间效应方差分析: F=292.548, P=0.000; 两组间效应对比: F=88.960, P=0.000.
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表 3 两组患者所测心脏彩超参数值（
$\, \overline{{x}}{{±}}{{s}}$ ）项目 治疗组 对照组 放疗前 放疗2周 放疗结束 放疗结束后4周 放疗前 放疗2周 放疗结束 放疗结束后4周 LADs 29.2±3.0 28.5±3.3 27.8±2.8 26.7±2.9 29.2±3.0 27.6±3.1 23.6.2±2.8 25.1±2.7 LVDd 44.6±2.3 44.3±2.4 44.9±2.4 45.1±2.2 44.6±2.3 43.8±2.3 43.2±2.4 42.8±2.4 EF 63.7±3.7 66.2±3.1 64.6±2.4 63.3±2.9 64.1±3.6 6.27±3.9 61.6±3.7 60.2±3.7 FS 33.3±2.2 33.3±1.6 33.5±2.2 32.4±2.0 32.3±1.6 31.7±1.7 30.0±1.6 28.6±1.5 E 67.7±10.3 66.0±11.6 63.3±10.7 61.8±10.8 68.9±9.7 63.9±11.2 60.1±11.3 56.2±11.1 A 72.0±5.9 73.8±6.3 75.3±6.1 76.5±6.3 70.7±5.3 73.7±5.8 75.4±6.0 77.7±6.0 E/A 0.9±0.2 0.9±0.2 0.8±0.2 0.8±0.2 1.0±0.2 0.9±0.2 0.8±0.2 0.7±0.2 Sa间隔侧 8.3±0.7 8.0±0.5 7.6±0.7 6.9±0.6 8.4±0.6 7.8±0.5 7.2±0.7 6.4±0.6 Sa外侧 10.9±1.8 9.1±1.2 9.3±1.4 9.4±1.6 11.0±1.7 9.3±1.2 8.9±1.2 8.1±1.4 Ea 8.9±1.4 8.5±1.3 8.8±1.4 9.1±1.0 9.5±1.1 8.7±1.2 8.1±1.1 7.3±1.0 Aa 8.2±1.5 7.2±1.3 7.0±1.4 6.9±1.3 8.2±1.5 7.1±1.4 6.7±1.2 5.8±1.0 Ea/Aa 1.1±0.2 1.2±0.2 1.3±0.3 1.3±0.2 1.2±0.2 1.2±0.3 1.2±0.2 1.3±0.2 LADs: 左心房收缩末期内径; LVDd: 左心室舒张末期内径; EF: 射血分数; FS: 短轴缩短率; E: 二尖瓣舒张早期峰值流速; A: 心房收缩期峰值流速; Sa间隔侧: 二尖瓣瓣环室间隔侧收缩期峰值速度; Sa外侧: 二尖瓣瓣环室外侧的收缩期峰值速度; Ea: 舒张早期峰值速度; Aa: 舒张晚期运动速度; 时间效应方差分析: P<0.05;两组间效应对比(LVDd, EF, FS, Sa间隔侧): P<0.05.
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