动态心电图评价舒尼替尼对肾细胞癌患者心脏毒性的临床价值

万建平 杨泽福 高耀铭

[摘要]目的探討动态心电图评价舒尼替尼对肾细胞癌（RCC）患者心脏毒性的临床价值。方法选取2019年2月至2021年3月佛山市南海区人民医院及佛山市第一人民医院接受舒尼替尼治疗的 RCC 患者96例，均于治疗前、治疗1个周期后检测动态心电图，根据1年内是否出现心脏毒性事件分为心脏毒性组（24例）、无心脏毒性组（72例），另选取同期48例健康体检者作为对照组，并进行动态心电图检测。比较三组一般资料及动态心电图参数[心率减速力（DC）、心率加速力（AC）、心率变异性（HRV）]，分析动态心电图参数与左室射血分数（LVEF）间关系及对心脏毒性的预测价值。结果三组吸烟情况、饮食习惯比较，差异有统计学意义（ P <0.05）;治疗1个周期心脏毒性组 LVEF、DC、全部窦性心博 RR 间期（SDNN）、连续5 min 节段平均RR 间期的标准差（SDANN）、相邻 RR 间期之差的均方根（RMSSD）低于无心脏毒性组， AC 高于无心脏毒性组（ P <0.05）;RCC患者治疗后DC、SDNN、SDANN、RMSSD与LVEF呈正相关，AC与LVEF呈负相关（ P <0.05）;logistic 回归方程校正吸烟、常食肉食混杂因素后，LVEF、DC、AC、SDNN、SDANN、RMSSD 仍与 RCC 患者心脏毒性发生有关（ P <0.05）。结论动态心电图参数变化与 RCC 患者心脏毒性发生关系密切，可为临床评估舒尼替尼对 RCC 患者心脏毒性提供新视角。

[关键词]动态心电图;肾细胞癌;心脏毒性;心率减速力;心率变异性

[中图分类号] R737.11  [文献标识码] A   [文章编号]2095-0616（2021）23-0190-05

Clinical value of dynamic electrocardiogram in evaluating the cardiotoxicity of sunitinib to patients with renal cell carcinoma

WANJianping1 YANGZefu1 GAOYaoming2

1.The People's Hospital of Nanhai District in Foshan City， Guangdong， Foshan 528000， China;2.The First People's Hospital of Foshan， Guangdong， Foshan 528000， China

[Abstract] Objective To explore the clinical value of dynamic electrocardiogram （DECG）in evaluating the cardiotoxicity of sunitinib to patients with renal cell carcinoma （RCC）. Methods A total of 96 RCC patients who were treated with sunitinib in the People's Hospital of Nanhai District in Foshan City and the First People's Hospital of Foshan from February 2019 to March 2021 were selected as research objects， and their DECG was detected before and after one cycle of treatment. They were divided into the cardiotoxic group （n=24） and the non-cardiotoxic group （n=72） according to whether there were any cardiotoxic events within one year. In addition， 48 healthy people in the same period were selected as the control group and the DECG was detected as well. The general data and DECG parameters （deceleration capacity of rate [DC]， acceleration capacity of rate [AC]， heart rate variability [HRV]） of the three groups were compared， and the relationship between DECG parameters and left ventricular ejection fraction （LVEF） and its predictive value for cardiotoxicity were analyzed. Results There were statistically significant differences in smoking and eating habits among the three groups （P <0.05）. After one cycle oftreatment， the LVEF， DC， standard deviation of normal-to-normal intervals （SDNN）， standard deviation of averaged normal –to-normal intervals （SDANN） and root mean square values of the standard deviation between adjacent normal number of intervals （RMSSD） in the cardiotoxic group were lower than those in the non-cardiotoxic group and the AC was higher than that in the non-cardiotoxic group （P <0.05）. After treatment， DC， SDNN， SDANN and RMSSD of RCC patients were positively correlated with LVEF， while AC was negatively correlated with LVEF （P <0.05）. After adjusting for smoking and meat ate frequently by logistic equation， LVEF， DC， AC， SDNN， SDANN and RMSSD were still related to the occurrence of cardiotoxicity in RCC patients （P <0.05）. Conclusion The change of DECG parameters is closely related to the occurrence of cardiotoxicity in RCC patients， which can provide a new perspective for clinical evaluation ofthe cardiotoxicity of sunitinib to RCC patients.

[Key words] Dynamic electrocardiogram; Renal cell carcinoma; Cardiotoxicity; Deceleration capacity of rate; Heart rate variability

肾细胞癌（renal cell carcinoma， RCC）是源于肾小管上皮的一种恶性肿瘤疾病，约占肾全部恶性肿瘤的80%以上[1]。RCC 早期症状隐匿，超过三分之一的患者确诊时已出现转移[2]。目前以舒尼替尼为代表的分子靶向药物尽管凭借低毒、高效等特征成为临床治疗转移性 RCC 的新手段，可高选择性杀灭癌细胞，但治疗过程中伴随着严重的心脏毒性反应，高达43%的患者可出现高血压，甚至充血性心力衰竭，而危及生命[3-4]。目前如何评价舒尼替尼治疗 RCC 过程中心脏毒性发生情况，以积极完善相关干预方案是临床急需解决问题之一。心脏彩超是当前临床诊断心脏疾病最便捷技术之一，而不足之处在于此技术所示病变多数已出现显著病理性改变[5]。……