摘要 目的探讨不同时间段、不同类型肿瘤、不同治疗方法下，胸部肿瘤患者接受调强放射治疗对动态心电图（AECG）的影响。方法选取在我院临床肿瘤中心接受调强放射治疗的胸部肿瘤患者126例，按照肿瘤类型分为左肺癌组43例，左乳癌组39例，食管癌组44例；按照治疗方法分为单纯放疗组36例，同步放化组46例，序贯放化组44例。分别于治疗前、治疗后和治疗结束半年后进行24 h Holter监测，比较这3个时间段的AECG异常发生率，以及在2种分类方法下各组治疗后新增AECG异常发生率。结果偶发房（室）性心律失常、ST-T改变在治疗后较治疗前明显增加，差异有统计学意义（P<0.05）；两者在治疗前与治疗结束半年后比较，差异无统计学意义（P>0.05）。分别比较不同类型胸部肿瘤、接受不同治疗方法的各3组患者治疗后新增AECG异常发生率，差异均无统计学意义（P>0.05）。结论调强放射治疗后胸部肿瘤患者的AECG改变多在治疗早期出现，是可逆性的。由于调强放射治疗的精确性，不同类型胸部肿瘤放疗后的AECG改变无显著性差异。紫杉醇+铂类化疗方案对AECG影响较小，其心脏毒性相对较低。
Abstract：ObjectiveTo explore the influence of intensity modulated radiation therapy(IMRT) on ambulatory electrocardiography(AECG), for patients with thoracic tumors at different stages, for different types of neoplasms and with different therapies.MethodsOne hundred and twentysix patients with thoracic tumors were enrolled in the research who had accepted IMRT at the Clinical Cancer Center in our hospital.According to the types of neoplasms, they were divided into 3 groups: left lung cancer group(43 cases), left mastocarcinoma group(39 cases) and esophageal cancer group(44 cases).And by the therapies, they were classified into radiotherapy group(36 cases), synchronal chemoradiation group(46 cases) and equential chemoradiation group(44 cases).All groups were monitored by 24hour AECG before, after and half a year after the treatment, and then compared about the abnormity incidence rates of AECG as well as the newly increased rates separately in the above two classifications.ResultsThe incidences of occasional atrial or ventricular arrhythmias and ST-T changes increased significantly after treatment compared with those before, and the differences were statistically significant(P<0.05).There was no statistical significance in the difference of the two AECG indexes before and half a year after therapy(P>0.05).There was also no statistical significance in the differences of newly increased abnormity incidence rates of 3 groups of patients, if we respectively made comparisons among different types of thoracic tumors and different therapies(P>0.05).ConclusionThe AECG changes of patients with thoracic tumors mostly occur at the early stage of IMRT and are reversible.Due to the precision of the therapy, there is no significant difference for different types of thoracic neoplasms in AECG changes after radiotherapy.The chemotherapy combined with Paclitaxel plus Taxanes has less effect on AECG with relatively low cardiac toxicity.
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2014, Vol. 23 
