采用 CT 血管造影术评估接受儿童霍奇金淋巴瘤治疗患者的冠状动脉疾病。
Evaluation of coronary artery disease by computed tomography angiography in patients treated for childhood Hodgkin's lymphoma.
机构信息
MSc, Hacettepe University, Institute of Oncology, Department of Pediatric Oncology, 06100, Ankara, Turkey.
出版信息
J Clin Oncol. 2010 Feb 20;28(6):1025-30. doi: 10.1200/JCO.2009.25.2627. Epub 2009 Dec 28.
PURPOSE To detect pathologies in coronary arteries by computed tomography angiography (CTA) in survivors of childhood Hodgkin's lymphoma who have been treated with radiotherapy and/or cardiotoxic agents. PATIENTS AND METHODS Patients with HL who have been in remission for at least 2 years after completion of therapy were included. CBC, lipid profile, urine analysis, brain natriuretic peptide, troponin-T, creatinine kinase-myocardial band, ECG, telecardiography, echocardiography, and CTA of the patients were performed. Cardiac vascular abnormalities were noted. Results A total of 119 patients were included in the study. In 19 patients (16%), we found coronary artery abnormalities. There was a significant difference between the patients who received mediastinal radiotherapy and those who did not (P = .02). By multivariate analysis, in patients receiving mediastinal radiotherapy the risk of developing a coronary artery abnormality was found to increase 6.8 times compared with patients who did not receive mediastinal radiotherapy (P = .009). Stent implantation was performed in a 28-year-old patient because of critical stenosis in right coronary. In two patients some irregularities were detected both in CTA and conventional angiography, and they remained in close follow-up. A 22-year-old patient whose CTA showed critical stenosis in his left anterior descending artery refused the conventional angiography. CONCLUSION To our knowledge, this is the first large study using CTA for detection of coronary abnormalities in patients treated for HL in pediatric age group. Coronary CTA is a minimally invasive tool for early diagnosis of coronary artery disease in patients who were treated with mediastinal radiotherapy and/or cardiotoxic chemotherapy.
目的 通过计算机断层血管造影术(CTA)检测接受放疗和/或心脏毒性药物治疗的儿童霍奇金淋巴瘤幸存者的冠状动脉病变。
患者和方法 纳入至少在完成治疗后 2 年缓解的霍奇金淋巴瘤患者。对患者进行 CBC、血脂谱、尿液分析、脑利钠肽、肌钙蛋白-T、肌酸激酶-MB、心电图、远程心电图、超声心动图和 CTA。注意心脏血管异常。
结果 共有 119 例患者纳入研究。在 19 例(16%)患者中,我们发现了冠状动脉异常。接受纵隔放疗的患者与未接受纵隔放疗的患者之间存在显著差异(P =.02)。通过多变量分析,在接受纵隔放疗的患者中,与未接受纵隔放疗的患者相比,发生冠状动脉异常的风险增加了 6.8 倍(P =.009)。一位 28 岁的患者因右冠状动脉临界性狭窄而植入支架。两名患者的 CTA 和常规血管造影均显示存在不规则,他们仍在密切随访中。一名 22 岁的患者的 CTA 显示其左前降支临界性狭窄,但拒绝接受常规血管造影。
结论 据我们所知,这是第一项使用 CTA 检测儿科年龄组接受 HL 治疗的患者冠状动脉异常的大型研究。冠状动脉 CTA 是一种用于早期诊断接受纵隔放疗和/或心脏毒性化疗的患者的冠状动脉疾病的微创工具。