摘要
目的观察治疗剂量的三氧化二砷(As2O3)对急性早幼粒细胞白血病(APL)患儿的心脏毒性。方法对37例APL患儿静脉滴注As2O3进行心脏毒性监测,观察患儿临床表现、心电图(ECG)、心肌酶谱(LDH、α-HBDH、CK、CK-MB、CK-MBMass和cTnI)、心脏扇扫超声、24h动态ECG等变化。结果 APL患儿37例中,5例(13.5%)诱导缓解期出现心悸、心前区不适,均在3周后消失,无明显心前区憋闷、钝痛等。未见明显ECG变化;与治疗前比较,cTnI和CK-MBMass在第2周、第3周均明显升高(Pa<0.01),CK-MBMass在第4周仍明显升高(P<0.05)。CK-MB在第2周开始显著升高(P<0.05),第3周达到高峰,之后逐渐下降。治疗前后CK、LDH和α-HBDH呈逐渐下降趋势,3周后均恢复正常;其中29例心脏扇扫超声均未发现异常;27例完全缓解超过2a者中,18例(66.7%)进行了24h动态ECG检查:4例(22.2%)有ST-T波异常。结论常规剂量As2O3治疗小儿APL心脏毒性较轻,安全可靠。As2O3累积量的变化对小儿心肌的近期影响不大,自觉症状不明显,动态检测CK-MB、cTnI和CK-MBMass变化可以早期发现砷剂的心肌损害。而24h动态ECG检查更易发现其早期电学变化。
Objective To study the cardiac toxicity in children with acute promyelocytic leukemia（APL） treated by arsenic trioxide of therapeutic dose.Methods Cardiac toxicity of 37 APL children were monitored：clinical symptoms,electrocardiogram,ultraphonic examination of heart,dynamic cardiograph analysis system,cardiac zymogram including LDH,α-HBDH,CK,CK-MB,CK-MB Mass and cTnI.Results Discomfortableness in precordial region occurred in 5 out of 37 cases in remission induction,all symptoms disappeared after 3 weeks.Obvious ECG changes were not found.CK,LDH and α-HBDH were downtrend gradually.CK,CK-MB and CK-MB mass recovered to normal after 2-3 weeks with treatments,all ultraphonic examination of heart were found normal,24 h dynamic cardiograph analysis：18 cases were examinated in 27 cases of duration of complete remission exceeding 2 years,abnormality of ST-T wave changes were monitored in 4 cases（22.2%）.Conclusions The cardiac toxicity of As2O3 is gently,its utilization is safety.Influence of As2O3 cumulant on myocardium is not serious in the near future in children,rational symptom is not obvious,obvious abnormality with routine examination is not found.CK-MB,cTnI and CK-MB Mass are ideal and specific sign in cardiac damage,the dynamic variety can prospect cardiac damage early with arsenic trioxide.Early changes are easy to be investigated by 24 h dynamic cardiograph analysis.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第15期1182-1184,共3页
Journal of Applied Clinical Pediatrics
