Hu Huimin, Zhang Weiling, Huang Dongsheng, Yang Qingmiao, Li Jing, Gao Yanan
a Department of Pediatrics, Beijing Tongren Hospital , Capital Medical University , Beijing China.
b Cardiovascular Center, Beijing Tongren Hospital , Capital Medical University , Beijing China.
Pediatr Hematol Oncol. 2018 Mar;35(2):111-120. doi: 10.1080/08880018.2018.1459983. Epub 2018 Apr 12.
To investigate the cardiotoxicity indexes in children with malignant tumors after the administration of anthracycline (ANT) chemotherapy.
Data from 131 children with malignant tumors who were treated using ANT chemotherapy at our hospital from January 2011 to December 2015 were collected to analyze the serologic indexes (such as N-terminal pro-brain natriuretic peptide [NT-proBNP] and isoenzyme of creatine kinase [CK-MB]) and changes in corrected QT interval(QT-c) and left ventricular ejection fraction (LVEF) before and after treatment with different ANT cumulative doses.
General clinical data revealed that 2 of the 131 children developed clinical cardiotoxicity. The ANT cumulative dose range was 12-697 mg/m. All patients were divided into three groups according to the ANT cumulative dose: group 1 (<100 mg/m), 2 (≥100 and <200 mg/m), and 3 (≥200 mg/m). Although NT-proBNP and LVEF among the three groups differed significantly after chemotherapy (p = 0.022 and 0.035, respectively), no significance was noted for CK-MB and QT-c among the three groups after chemotherapy (p = 0.190 and p = 0.084, respectively). Multiple linear regression analysis revealed that the ANT cumulative dose had the most significant impact on NT-proBNP (standardized coefficient 0.423, p = 0). Pearson correlation analysis revealed that ANT cumulative dose was positively correlated with NT-proBNP post-treatment (correlation coefficient 0.423), but LVEF was negatively correlated with NT-proBNP after chemotherapy (correlation coefficient -0.542).
NT-proBNP showed significant changes when the ANT dose was >200 mg/m. Post-treatment serum NT-proBNP was linearly correlated with ANT cumulative dose, hence strictly controlling the ANT cumulative dose and monitoring serum NT-proBNP may have certain clinical significance in predicting cardiotoxicity.
探讨蒽环类药物（ANT）化疗后恶性肿瘤患儿的心脏毒性指标。
收集2011年1月至2015年12月在我院接受ANT化疗的131例恶性肿瘤患儿的数据，分析不同ANT累积剂量治疗前后的血清学指标（如N末端脑钠肽前体[NT-proBNP]和肌酸激酶同工酶[CK-MB]）以及校正QT间期（QT-c）和左心室射血分数（LVEF）的变化。
一般临床资料显示，131例患儿中有2例出现临床心脏毒性。ANT累积剂量范围为12 - 697mg/m。所有患者根据ANT累积剂量分为三组：第1组（<100mg/m）、第2组（≥100且<200mg/m）和第3组（≥200mg/m）。化疗后三组间NT-proBNP和LVEF差异有统计学意义（分别为p = 0.022和0.035），但化疗后三组间CK-MB和QT-c差异无统计学意义（分别为p = 0.190和p = 0.084）。多元线性回归分析显示，ANT累积剂量对NT-proBNP影响最显著（标准化系数0.423，p = 0）。Pearson相关分析显示，治疗后ANT累积剂量与NT-proBNP呈正相关（相关系数0.423），但化疗后LVEF与NT-proBNP呈负相关（相关系数 - 0.542）。
当ANT剂量>200mg/m时，NT-proBNP有显著变化。治疗后血清NT-proBNP与ANT累积剂量呈线性相关，因此严格控制ANT累积剂量并监测血清NT-proBNP对预测心脏毒性可能具有一定的临床意义。
