蒽环类药所致儿童心功能损害及其监测

Cardiac toxicity and mornitoring in children with anthracycline therapy

摘要:

目的 指导临床使用蒽环类药，减少药物毒性所致心功能损害。方法 超声心动图、心电图、心肌酶谱及胸部X线片，检测白血病、淋巴瘤患儿化疗前后的心功能状态。结果 85例患儿131次超声心动图测定，异常率38.82％，化疗前异常率20.93％(9／43)，化疗后异常率50％(21／42)，蒽环类药累积计量≥350mg/M2者，异常率明显增高。2例死于心肌病者药物累积量为100mg/M2和454.35mg/M2。结论 对白血病、淋巴瘤患儿作化疗前后心功能监测十分必要，临床应根据葸环类药物累积总量及心功能状态调整化疗用药；超声心动图监测心功能敏感且实用。

Abstract:

Objective To guide the clinical use of anthracycline in childhood leukemia and lymphoma patients, and to lessen the anthracycline-induced cardiac impairment.Methods Echocardiography, electrocardiography, myocardio-enzymes and chest X-ray were used to evaluate the cardiac function before and after chemotherapy. Results In 85 cases the total abnormal rate of echocardiogram was 38.82% (33/85), 20.93% (9/43) prechemotherapy and 50% (21/42) post-chemotherapy. The abnormal rate increased apparently in patients whose anthracycline cumulative dosage was ≥350 mg/M 2 . Two patients died of cardiomyopathy,whose cumulative dosages were 100 mg/M 2 and 454.35 mg/M 2 respectively . Conclusions It is recommended to monitor cardiac function in childhood leukemia and lymphoma during chemotherapy period. The dose of anthracycline should be modified according to the cardiac function and the cumulative dosage. It is sensitive and practicable for echocardiography to monitoring cardiac function.