Krystal Julie I, Reppucci Marina, Mayr Theresa, Fish Jonathan D, Sethna Christine
Division of Pediatric Hematology-Oncology, Cohen Children's Medical Center, New Hyde Park, New York, 11040.
Hofstra Northshore-LIJ School of Medicine, Hempstead, New York.
Pediatr Blood Cancer. 2015 Oct;62(10):1832-7. doi: 10.1002/pbc.25547. Epub 2015 Apr 20.
Cardiovascular disease is prevalent among childhood cancer survivors (CCS). Arterial stiffness measured by pulse wave velocity (PWV) may be predictive of cardiovascular morbidity. Increased PWV has been seen in adults following chemotherapy.
To evaluate PWV in a cohort of CCS and healthy controls.
All participants were >6 years old. CCS were >12 months off-therapy and free of cardiac disease, diabetes, and kidney dysfunction. Height, weight, blood pressure (BP), medications, cancer diagnosis, age at diagnosis, time off therapy, chemotherapy, and radiation exposures were recorded. PWV was measured on all participants.
Sixty-eight CCS (mean 17.3 ± 6 years, 52.9% male), and 51 controls (mean 18.4 ± 5.5 years, 37.3% male) were evaluated. Among CCS, 34% had lymphoma, 44% leukemia, and 22% solid tumors, and 49% were exposed to radiation. CCS were off therapy 7 ± 4.2 years. Both groups were statistically similar in age, BMI, and BP. CCS ≥ 18 years old had significantly higher PWV compared to controls ≥ 18 years old (6.37 ± 0.89 vs. 5.76 ± 0.88 m/sec, P = 0.012). The relationship persisted in a regression model adjusted for age, sex, and BMI z-score (β = 0.52, 95%CI 0.051-0.979, P = 0.03). Seventy percent of CCS ≥ 18 had elevated PWV compared to established norms. Radiation therapy, anthracycline dose, and chemotherapy exposures were not predictive of increased PWV in CCS.
CCS ≥ 18 demonstrated prematurely elevated PVW. Further studies are needed to determine the predictive value of PWV in this population and its utility as a screening modality.
心血管疾病在儿童癌症幸存者（CCS）中很常见。通过脉搏波速度（PWV）测量的动脉僵硬度可能是心血管疾病发病的预测指标。化疗后的成年人中已观察到PWV升高。
评估一组CCS和健康对照者的PWV。
所有参与者年龄均大于6岁。CCS停止治疗超过12个月，且无心脏病、糖尿病和肾功能不全。记录身高、体重、血压（BP）、用药情况、癌症诊断、诊断时年龄、停止治疗时间、化疗和放疗暴露情况。对所有参与者测量PWV。
评估了68例CCS（平均17.3±6岁，52.9%为男性）和51例对照者（平均18.4±5.5岁，37.3%为男性）。在CCS中，34%患有淋巴瘤，44%患有白血病，22%患有实体瘤，49%接受过放疗。CCS停止治疗7±4.2年。两组在年龄、BMI和BP方面在统计学上相似。18岁及以上的CCS的PWV显著高于18岁及以上的对照者（6.37±0.89 vs. 5.76±0.88米/秒，P = 0.012）。在调整了年龄、性别和BMI z评分的回归模型中，这种关系仍然存在（β = 0.52，95%CI 0.051 - 0.979，P = 0.03）。与既定标准相比，70%的18岁及以上的CCS的PWV升高。放疗、蒽环类药物剂量和化疗暴露不能预测CCS中PWV的升高。
18岁及以上的CCS表现出PWV过早升高。需要进一步研究以确定PWV在该人群中的预测价值及其作为筛查方式的效用。
