摘要
目的分析肿瘤患者使用免疫检查点抑制剂(ICI)后心律失常发生情况及心电图特征的变化。方法本研究为一项队列研究,选取2020年11月至2022年9月于河北医科大学第四医院接受ICI治疗的肿瘤患者,对其接受ICI治疗前后的标准12导联心电图进行分析比较。其中,出现窦性心律失常、心房颤动、心房扑动、阵发性室上性心动过速、室性心动过速、早搏、传导阻滞、ST-T改变等异常心电现象中任何1种,则该份心电图被定义为异常心电图。结果共纳入87例患者,年龄63(57,68)岁,男性66例(75.9%)。44.8%(39/87)的患者在接受ICI治疗前即存在至少1种心血管疾病或危险因素。在接受(5.0±2.7)个周期的ICI治疗后,与基线水平比较,异常心电图发生率升高[65.5%(57/87)比31.0%(27/87),P<0.001];ICI治疗后窦性心律失常发生率高于基线[23.0%(20/87)比9.2%(8/87),P=0.023],其中,以窦性心动过速患者的比例升高为著[11.5%(10/87)比2.3%(2/87),P=0.039]。ICI治疗后心电图出现ST-T改变的患者比例高于基线[31.0%(27/87)比17.2%(15/87),P=0.012],主要归因于T波改变的发生率升高[29.9%(26/87)比13.8%(12/87),P=0.001]。此外,ICI治疗后早搏的发生率较治疗前升高[9.2%(8/87)比0,P=0.008]。心电图各指标中,接受ICI治疗后患者的P波电轴较基线增大[(56.94±21.01)°比(52.00±22.69)°,P=0.043],静息心率较前升高[(79.07±15.37)次/min比(75.64±13.37)次/min,P=0.029];Sokolow-Lyon指数较基线有下降趋势[(2.21±0.81)mV比(2.33±0.75)mV,P=0.138],QTc间期较基线有延长趋势[(431.44±36.04)ms比(428.00±30.05)ms,P=0.415]。结论肿瘤患者在接受ICI治疗后异常心电图的发生率升高,其中主要以窦性心动过速、T波改变、早搏的发生率增高为主,心电图P波电轴在治疗后增大、静息心率加快,提示对于接受ICI治疗的肿瘤患者,进行规律的心电监测十分重要。
Objective To evaluate the incidence of arrhythmias and electrocardiographic(ECG)characteristics in cancer patients treated with immune checkpoint inhibitors(ICIs).Methods This was a cohort study conducted in the Fourth Hospital of Hebei Medical University.Cancer patients initiating ICIs treatments from November 2020 to September 2022 were included in this study.Baseline 12-leads ECG before ICIs initiation and post-treatment ECG were analyzed.An abnormal ECG was defined as the presence of any of the following changes:sinus arrhythmias,atrial fibrillation,atrial flutter,paroxysmal supraventricular tachycardia,ventricular tachycardia,premature contractions,conduction disorder,and ST-T changes.Results A total of 87 patients were enrolled,aged 63(57,68)years,with 66(75.9%)males.And 44.8%(39/87)of patients presented with at least one confirmed cardiovascular disease or cardiovascular risk factor at baseline.The incidence of abnormal ECG increased from 31.0%(27/87)at baseline to 65.5%(57/87)after receiving(5.0±2.7)cycles of ICIs treatment(P<0.001).The incidence of sinus arrhythmias was significantly increased after ICIs treatment(23.0%(20/87)vs.9.2%(8/87),P=0.023),of which only the incidence of sinus tachycardia was significantly increased(11.5%(10/87)vs.2.3%(2/87),P=0.039).There was also a significantly increased incidence of ST-T changes after ICIs treatment(31.0%(27/87)vs.17.2%(15/87),P=0.012),which mainly attributed to the T wave changes(29.9%(26/87)vs.13.8%(12/87),P=0.001).The incidence of premature contractions was also significantly increased after ICIs treatment(9.2%(8/87)vs.0,P=0.008).Additionally,compared with baseline,the P wave axis was significantly increased after ICIs treatment((56.94±21.01)°vs.(52.00±22.69)°,P=0.043).After ICIs treatment,the heart rate was significantly increased((79.07±15.37)beats/min vs.(75.64±13.37)beats/min,P=0.029).Sokolow-Lyon index((2.21±0.81)mV vs.(2.33±0.75)mV,P=0.138),QTc interval((431.44±36.04)ms vs.(428.00±30.05)ms,P=0.415)all showed signs of change after treatment
作者
耿旭红
张楠
宋文华
成思瑶
郑屹
马潇桐
王莉
李选
刘彤
Geng Xuhong;Zhang Nan;Song Wenhua;Cheng Siyao;Zheng Yi;Ma Xiaotong;Wang Li;Li Xuan;Liu Tong(Department of Function,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Cardiology,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease,Tianjin Institute of Cardiology,Second Hospital of Tianjin Medical University,Tianjin 300211,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2024年第6期690-697,共8页
Chinese Journal of Cardiology
基金
天津市医学重点学科(专科)建设项目(TJYXZDXK-029A)。
