| Objective: Anthracyclines have been widely used in childhood cancers,especially hematologic malignancies and certain solid tumors,then have improved the event-free survival significantly.The anthracyclines' side effects are gradually understood and potentially cardiotoxicity that limits the clinical application and impacts life quality is most serious.Therefore,how can early monitor anthracycline-induced cardiotoxicity has become a hot topic in clinical research.We study cardiotoxicity by electrocardiogram(ECG),echocardiography(LVEF,E/A,Tei index)and biochemical indicators(CK,CK-MB,c Tn I,BNP),analysised anthracycline-related cardiotoxicity in different cumulative dose of children.We hope to look for sensitive indicators monitoring early heart injure and improve survival and life quality in children with cancer.Method:We selected 35 cases that were accepted anthracyclines treatment.These cases come from the pediatrics of The Fourth Hospital of Hebei Medical University,which were diagnosed as cancer come from June2015 to December 2016.All the subjects must meet the following criteria:age is 0-14 years old;they diagnosed as cancer including hematologic malignancies or solid tumors;they have not heart injure before exposed to anthracyclines and accept chemotherapy for the first time.All patients exclude the following diseases:congenital heart diseases or other heart diseases,hypertension,diabetes and chronic systemic diseases,electrolytes and acid-base balance disorders.The 33 children were identified:20 males and 13 females,1-14 years old,mean age:7.39 years(median age 7 years).There are 13 cases of lymphoma(11 cases of non-Hodgkin lymphoma,2 cases of Hodgkin lymphoma),11 cases of acute leukemia(8 cases of acute lymphoblastic leukemia and 3 cases of acute myelocytic leukemia)and 9 cases of solidtumors(4 cases of neuroblastoma,2 cases of nephroblastoma and 3 cases of rhabdomyosarcoma).We analysise the changes of electrocardiogram,echocardiography and biochemical indicators at the cumulative anthracycline doses of0-100mg/m2,100-200mg/m2,200-250mg/m2 and more than 250mg/m2.The data were analyzed with SPSS 21.0 software.Results:1 Electrocardiogram1.1 Comparison of abnormal rate of electrocardiogram before and after treatment of anthracyclinesAfter the anthracycline therapy,9 of 33 cases of childhood cancer had a abnormal ECG.The abnormal rate was 27.27%,and the difference was statistically significant(P<0.05).1.2 Comparison of abnormal rate of electrocardiogram before and after anthracyclines used in different cumulative doseThe abnormal rates of ECG were 0%,3.03%,3.03% and 7.14%,respectively,before treatment of anthracyclines and the cumulative dose of0-100mg/m2,100-200mg/m2,200-250mg/m2.Compared with before treatment of anthracyclines,the difference was no statistically significant(P>0.05).The abnormal rates of ECG were 0% and 23.80%,respectively,before treatment of anthracyclines and the cumulative dose of more than250mg/m2.The difference between the two groups was statistically significant(P <0.05).2 EchocardiographyThe LVEF and E/A showed no statistically significant differences(P>0.05)before and after chemotherapy,while there was differences(P<0.05)in Tei index.The Tei index of cumulative dose of 0-100mg/m2,100-200mg/m2 compared with before treatment of anthracyclines,the differences were no statistically significant(P>0.05).The Tei index of cumulative dose of200-250mg/m2,>250mg/m2 compared with before treatment of anthracyclines,the differences were statistically significant(P<0.05).3 Biochemical indicatorsThe CK,CK-MB and c Tn I showed no statistically significant differences(P>0.05)before and after chemotherapy,while there was differences(P<0.05)in BNP.The BNP of cumulative dose of 0-100mg/m2,100-200mg/m2 and200-250mg/m2 compared with before treatment of anthracyclines,the differences were no statistically significant(P>0.05).The BNP of cumulative dose of >250mg/m2 compared with before treatment of anthracyclines,the difference was statistically significant(P<0.05).4 correlation analysis of the Tei index,the abnormal rates of ECG,and BNPThe Tei index and the abnormal rates of ECG,the Tei index and BNP were positively correlated(r=0.986,P=0.002;r=0.779,P<0.001 respectively).Conclusion:1 The anthracyclines' cardiotoxicity correlated with the accumulated dose.2 The ECG,the Tei index and BNP can be used as early indexes for monitoring the anthracyclines' cardiotoxicity.The increased Tei index is more sensitive to myocardial injury than the ECG and BNP.3 The LVEF,E/A,myocardial enzymes can not be used as a sensitive indicator of early monitoring of myocardial injury.But once the abnormal,they may indicate serious myocardial damage.4 In the early stage of cardiac toxicity of anthracycline drugs,active administration of clinical intervention can effectively improve myocardial injury. |
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