调强放疗对肺癌患者心电图心肌酶谱及B型利钠肽的影响

  目的  探讨调强放疗（intensity modulated radiation therapy，IMRT）对肺癌患者心电图、心肌酶谱及B型利钠肽的影响。  方法  回顾性分析天津医科大学肿瘤医院2013年6月至2015年6月接受IMRT的肺癌患者203例，比较分析放疗前、放疗后1个月、2个月及3个月的心电图、心肌酶谱及B型利钠肽的变化，采用Logistic回归分析对可能引起上述指标异常的临床因素进行分析。  结果  放疗后心电图异常率52.1%，大多发生在放疗后第1个月，以ST-T改变为主，IMRT后患者心电图ST-T改变较放疗前的发生率明显增加，差异具有统计学意义（P < 0.001）；放疗后心肌酶谱和B型利钠肽异常率分别为39.9%和4.9%，放疗后2个月肌酸激酶、肌酸激酶同工酶及B型利钠肽明显升高，差异具有统计学意义（P=0.034，P=0.045，P=0.012）。肿瘤大体分型、治疗方式及放疗总剂量是影响肺癌患者放疗后心电图改变的独立危险因素；放疗总剂量是影响心肌酶谱及B型利钠肽改变的独立危险因素。  结论  肺癌IMRT可导致心电图、肌酸激酶、肌酸激酶同工酶及B型利钠肽异常，其异常程度与放疗总剂量密切相关。 

Effect of intensity modulated radiotherapy on electrocardiogram,myocardial enzyme spectrum and B type natriuretic peptidein in lung cancer patients

  Objective  To assess the effect of intensity modulated radiotherapy (IMRT) on electrocardiogram (ECG) findings and myocardial enzyme spectrum and B-type natriuretic peptide (BNP) levels in patients with lung cancer.   Methods  We retrospectively reviewed the data of patients treated with IMRT at Tianjin Medical University Cancer Institute and Hospital between June 2013 and June 2015. In total, 203 patients were included. All patients underwent ECG and tests to determine myocardial enzyme spectrum and BNP levels before and 1, 2, and 3 months after IMRT. Risk factors were also evaluated.  Results  The data revealed that the incidence of an abnormal ECG finding was 52.1% and that it mostly occurred in the first month after IMRT. The main abnormality noted was ST-T changes. The occurrence rate of ST-T changes after IMRT was statistically significant (P < 0.001). The incidences of abnormal myocardial enzyme spectrum and BNP levels were 39.9% and 4.9%, respectively. During the first 2 months after IMRT, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), and BNP levels significantly increased (P=0.034; P=0.045; P=0.012). Tumor classification, concurrent chemoradiation, and total radiation dose were independent risk factors for abnormal ECG findings, whereas total radiation dose was an independent risk factor for abnormal myocardial enzyme spectrum and BNP levels.   Conclusion  IMRT can result in abnormal ECG findings and abnormal CK, CK-MB, and BNP levels in patients with lung cancer. These damages are closely associated with the total radiation dose.