Kállay Krisztián, Zakariás Dávid, Csordás Katalin, Benyó Gábor, Kassa Csaba, Sinkó János, Stréhn Anita, Horváth Orsolya, Vásárhelyi Barna, Kriván Gergely
Pediatric Hematology and Stem Cell Transplantation Unit, United St. István and St. László Hospital, Albert Flórián street 5-7, Budapest, H-1097, Hungary.
Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
Pathol Oncol Res. 2019 Apr;25(2):487-492. doi: 10.1007/s12253-018-0403-y. Epub 2018 Mar 9.
In antithymocyte globulin (ATG) treated patients occasionally bradycardia has been noticed. Therefore, we retrospectively analyzed the occurrence of bradycardia in ATG-treated children. Using medical records between 2007 and 2012 we identified children undergoing a combined therapy with ATG and glucocorticoids (ATG group, n = 22). The incidence of bradycardia was compared to that registered in children treated with glucocorticoids alone (glucocorticoid alone group, n = 21). Heart rates (HR) were registered before and on days 0-3, 4-7 and 8-14 after the ATG or steroid administration. The rate of bradycardic episodes was higher during ATG therapy than in the steroid alone group, while severe bradycardia occurred only in the ATG group (97 versus 32, p = 0.0037, and 13 versus 0, p = 0.0029, respectively). There was an interaction between the time and treatment group on HR (p = 0.046). Heart rates in ATG and steroid alone groups differed significantly on day 0-3 and day 4-7 (p = 0.046, p = 0.006, respectively). Within the ATG group HR was lower on days 4-7 compared to the days before and the days 8-14 values (p < 0.001, 95%CI: 0.020-0.074). These findings indicate that transient asymptomatic bradycardia is probably more common with ATG therapy than previously reported. HR should be closely monitored during and after ATG therapy.
在接受抗胸腺细胞球蛋白（ATG）治疗的患者中，偶尔会注意到心动过缓。因此，我们回顾性分析了接受ATG治疗的儿童心动过缓的发生情况。利用2007年至2012年的医疗记录，我们确定了接受ATG和糖皮质激素联合治疗的儿童（ATG组，n = 22）。将心动过缓的发生率与仅接受糖皮质激素治疗的儿童（仅糖皮质激素组，n = 21）进行比较。在给予ATG或类固醇之前以及给药后第0 - 3天、4 - 7天和8 - 14天记录心率（HR）。ATG治疗期间心动过缓发作的发生率高于仅使用类固醇的组，而严重心动过缓仅发生在ATG组（分别为97例对32例，p = 0.0037，以及13例对0例，p = 0.0029）。时间和治疗组之间在心率方面存在交互作用（p = 0.046）。ATG组和仅使用类固醇组的心率在第0 - 3天和第4 - 7天有显著差异（分别为p = 0.046，p = 0.006）。在ATG组中，第4 - 7天的心率低于给药前以及第8 - 14天的值（p < 0.001，95%CI：0.020 - 0.074）。这些发现表明，短暂无症状性心动过缓在ATG治疗中可能比以前报道的更常见。在ATG治疗期间及之后应密切监测心率。
