| In the last few years, the incidence rate of malignant tumor in China keepsrising, Operation treatment, radiotherapy and chemotherapy are the majortreatments, Among them, radiotherapy is the main method in the treatments ofthoracic malignant tumors.The heart which is located between the lung,inevitably is exposed to irradiation to some degree. Along with the increase ofradiation therapy in clinical application, Radiation Induced Heart Disease(RIHD) incidence continues to rise, gradually becoming a serious threat to thecardiac function of patients with thoracic radiotherapy, which is one of themain causes of the death of cancer patients. Therefore, the early detection ofRadiation Induced Heart Disease is crucial to improve the treatment effect ofthe patients and their life quality. And it is concluded that our study is a newmethod of diagnosis of radiation-induced heart disease by comparingconcentration of the plasma brain natriuretic peptide and the troponin ofpatients with chest tumor in their different radiotherapy periods.Objective:Study the electrocardiogram, myocardial enzyme, troponin and plasma brainnatriuretic peptide of patients with thoracic radiotherapy in different periodsand the relation between various physical factors and radiation induced heartinjury, in order to further clarify the evaluation value of the plasma brainnatriuretic peptide in radioactive heart injury.Methods:Collect30patients with chest tumor who meet the inclusion criteria andreceive three-dimensional conformal radiotherapy for the first time (including12female,18male,18patients suffering lung cancer,7cases with esophagealcarcinoma,4cases with carcinoma of the left breast, and1cases thymoma), All the patients were used Elekta linear accelerator, using coplanar3-5wild3D conformal radiotherapy and spiral CT simulation,1.8-2Gy each time,5times a week. For all patients the total irradiation dose was50-70Gy.Complete the following checks before radiotherapy: routine history taking andphysical examination, blood routine, liver and kidney function, electrolyte,blood sugar, cardiac troponin, myocardial enzymes, plasma brain natriureticpeptide concentration, electrocardiogram, ultrasound Beckoning diagram; inthe second, fourth weeks of radiotherapy, test the concentration of cardiactroponin and BNP in plasma as well as electrocardiogram, In the sixth week,the third and sixth month after radiotherapy, test the cardiac troponin, plasmabrain natriuretic peptide concentration detection and carry out ECG,ultrasound Heartbeat graph examination. Compare the changes of thelaboratory indexes and electrocardiogram parameters layer through thedifferent periods, different radiation dose, different irradiation volumes of theheart, different ages and sexes.Results:1. The research shows that the ECG abnormality mostly occurs during the first4-6weeks of radiation, totally there being11cases (36.7%): including twowith tachycardia or bradycardia (6.7%),7with T wave flat (23.3%),5with STsegment depression (16.7%), one with I degree atrioventricular block (3.3%).2. There are8patients suffering Troponin elevation (26.7%). In the sixthradiotherapy week, serum cardiac troponin is higher compared with that of6weeks before(F=3.31, P <0.05); Besides, there are7with serum myocardialzymogram increase (23.3%). After6weeks of radiotherapy, serum CK,CK-MB significantly increase than that before (P <0.001), while the LDH hasno significant change before and after radiotherapy (P>0.05).3. In the sixth week, plasma BNP concentration of the patients with RIHD ishigher than that of those without RIHD(P <0.05).4. The clinical factors (gender, age, smoking history, history of operation, KPSscore) and physical factors (V10, V20, V30, V40, V50, V60) of the patientswith RIHD and those without RIHD is not statistically significant(P>0.05). We haven’t found any factors in clinical and physical factors that areassociated with the occurrence of RIHD.Conclusion:The most common abnormality of the patients with RIHD is the change ofelectrocardiogram which occurs earlier. The abnormality often includes:lowering of T wave, ST segment depression, tachycardia orbradycardia.Plasma cardiac troponin I, myocardial enzyme spectrum and brainnatriuretic peptide will rise in the early period of radiotherapy,which can beused as early diagnostic indicators of radioactive heart injury.The clinical andphysical factors difference between RIHD group and non RIHD group werenot statistically significant. That we haven’t found the clinical and physicalfactors which are associated with radioactive heart injury may be related to thefact that we haven’t collect enough cases into our study. |
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