人环素对患有急性淋巴细胞白血病的儿童心率波动的影响:早期毒性迹象-试点研究
Diana R Lazar1,2, Simona Cainap2,3, Dana Maniu4
1Department No. 11, Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Journal of clinical medicine
|November 25, 2023
概括
患有白血病的儿童的抗环素化疗可以导致早期的心脏自主功能障碍,这表明心率变化率 (HRV) 降低. 通过霍尔特心电图监测HRV可以在症状出现之前检测出亚临床心脏毒性.
科学领域:
- 心脏病学 心脏病学
- 儿科瘤学 儿科瘤学
- 自主神经系统研究 自主神经系统研究
背景情况:
- 人环素是重要的化疗剂,但具有长期心脏毒性风险.
- 心率变化降低 (HRV) 是自主功能障碍和心脏健康降低的标志物.
- 早期发现心脏毒性对于儿童癌症患者的长期健康管理至关重要.
研究的目的:
- 为了评估急性淋巴细胞白血病接受 antracycline 治疗的儿童HRV 的变化.
- 在达到总累积剂量之前识别心脏自主功能障碍的早期迹象.
- 评估HRV作为亚临床心脏毒性生物标志物的有用性.
主要方法:
- 研究了一组35名患有急性淋巴细胞白血病的儿科患者.
- 24小时的霍尔特心电图监测在基线和累计剂量为120 mg/m2的多克索鲁比辛等效后进行.
- 分析了时间域和频域HRV参数,心律失常,心和心跳动.
主要成果:
- 在人环素治疗后观察到时间域和频域HRV参数的显著下降.
- LF/HF比率显示出显著差异 (p=0.035),表明早期的心脏自主功能障碍.
- 没有患者表现出临床心脏病症状或升高的热素;只有两人表现出心声回声学上的腹痛功能障碍.
结论:
- 在儿童中,人环素治疗损害了心脏自主神经系统调节,甚至在达到全部累积剂量之前.
- HRV参数作为亚临床心脏毒性的早期指标.
- 对于接受 antracyclines 的瘤患者来说,Holter ECG 监测是必不可少的,以检测早期的心脏损害.
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