高剂量联合化疗引起的急性致死性心肌炎。一种独特的临床和病理实体。

Acute lethal carditis caused by high-dose combination chemotherapy. A unique clinical and pathological entity.

作者信息

Appelbaum F, Strauchen J A, Graw R G, Savage D D, Kent K M, Ferrans V J, Herzig G P

出版信息

Lancet. 1976 Jan 10;1(7950):58-62. doi: 10.1016/s0140-6736(76)90151-3.

Abstract

An acute lethal myopericarditis has been observed in four out of fifteen patients receiving high-dose combination chemotherapy which includes cyclophosphamide 45 mg/kg/day for four days. In all cases the myopericarditis occurred 5-9 days after the initiation of chemotherapy, with dyspnoea, tachycardia, orthostatic hypotension, fluid retention, decreased voltage on electrocardiography, and pericardial effusion documented by echocardiogram, and progressed in 2 to 6 days to a fatal low-output state despite vigorous treatment. In three of the four patients, necropsy was permitted and revealed the unique pathological finding of fibrin microthrombi in capillaries, fibrin strands in the interstitium, and fibrin strands within the heart-muscle cells.

摘要

在15名接受大剂量联合化疗的患者中，有4名出现了急性致死性心肌心包炎，该联合化疗方案包括连续4天给予环磷酰胺45mg/kg/天。在所有病例中，心肌心包炎均发生在化疗开始后的5至9天，表现为呼吸困难、心动过速、体位性低血压、液体潴留、心电图电压降低以及超声心动图显示的心包积液，尽管进行了积极治疗，但在2至6天内病情进展为致命的低输出状态。4名患者中有3名接受了尸检，结果显示出独特的病理表现，即毛细血管内有纤维蛋白微血栓、间质中有纤维蛋白条索以及心肌细胞内有纤维蛋白条索。