调强放射治疗对左侧乳腺癌保乳术后患者心肌损伤的影响

doi:10.3877/cma.j.issn.1674-0785.2019.03.004

目的

研究调强放射治疗（放疗）对左侧乳腺癌保乳术后患者心肌损伤的影响。

方法

选取2018年6月至12月在北京大学肿瘤医院放疗科治疗的42例左侧乳腺癌保乳术后接受调强放疗的患者，分别在放疗前后采用化学发光微粒子免疫检测法测定血清超敏心肌肌钙蛋白I（cTnI）。对42例患者放疗前后血清超敏cTnI做Kolmogorov-Smirnova正态性检验，P≥0.05表示服从正态分布，采用配对样本t检验，反之采用相关样本非参数检验。对于患者放疗前后超敏cTnI阳性率采用χ²检验。

结果

42例患者放疗后血清超敏cTnI水平与放疗前比较明显增高［（0.008±0.013）μg/L vs（0.006±0.010）μg/L］，差异具有统计学意义（Z=-3.098，P=0.002）；放疗前后血清超敏cTnI阳性率差异无统计学意义（0 vs 4.8%，χ²=4.000，P=0.261）。

结论

调强放疗对于左侧乳腺癌保乳术后患者血清超敏cTnI指标较敏感，但不会引起明显的急性心肌损伤。

关键词: 乳腺癌, 保留乳房手术, 血清超敏心肌肌钙蛋白I, 强调放射治疗

Objective

To investigate the impact of intensity-modulated radiotherapy (IMRT) on myocardial damage in left-side breast cancer patients after breast-conserving surgery.

Methods

Forty-two left-side breast cancer patients treated by IMRT after breast-conserving surgery were selected at the Department of Radiotherapy of Peking University Cancer Hospital from June to December 2018. Their serum hypersensitivity cardiac troponin I (cTnI) levels were measured by chemiluminescence microparticle immunoassay before and after IMRT. The Kolmogorov-Smirnov normality test was used to compare the changes of serum hypersensitivity cTnI before and after IMRT. For data following a normal distribution, the paired-samples t-test was used, otherwise the non-parametric test was used. The χ² test was used for comparing the positive rate of hypersensitive cTnI before and after IMRT.

Results

Serum hypersensitivity cTnI values of the 42 patients increased significantly after IMRT compared to the values before treatment [(0.008±0.013) μg/L vs (0.006±0.010) μg/L, Z=-3.098, P=0.002], whereas the difference in the positive rates of serum hypersensitivity cTnI before and after IMRT was not statistically significant (0 vs 4.8%, χ²=4.000, P=0.261).

Conclusion

Serum hypersensitivity cTnI is sensitive to IMRT for left-side breast cancer patients after breast-conserving surgery, but significant myocardial damage may not occur under the limited dose.

Key words: Breast cancer, Breast conserving surgery, Serum hypersensitivity cardiac troponin I, Intensity-modulated radiotherapy

图1 42例患者调强放疗计划平均剂量体积直方图和误差条

图2 42例患者放疗前后血清超敏cTnI水平

表1 42例患者放疗前后血清超敏cTnI检测结果比较

?	放疗前	放疗后	统计值	P值
超敏cTnI（μg/L，±s）	0.006±0.010	0.008±0.013	Z=-3.098	0.002
超敏cTnI阳性［例（%）］	0（0）	2（4.8%）	χ²=4.000	0.261

表1 42例患者放疗前后血清超敏cTnI检测结果比较

?	放疗前	放疗后	统计值	P值
超敏cTnI（μg/L，±s）	0.006±0.010	0.008±0.013	Z=-3.098	0.002
超敏cTnI阳性［例（%）］	0（0）	2（4.8%）	χ²=4.000	0.261

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Impact of intensity-modulated radiotherapy on myocardial damage in left-side breast cancer patients after breast-conserving surgery

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Impact of intensity-modulated radiotherapy on myocardial damage in left-side breast cancer patients after breast-conserving surgery