张少阳 郭贞 刘玉芝 任玉华 许宗磊

【摘要】目的 分析HER2阳性乳腺癌患者应用TCH方案新辅助化疗前后的心电图变化，探讨TCH方案新辅助化疗对心脏电活动的毒性作用。方法 采用回顾性分析方法，回顾分析了2020年1月至2020年12月在我院住院，术前应用TCH方案新辅助化疗治疗6周期的HER2阳性的40例乳腺癌患者的临床资料，对治疗前后的体表心电图进行分析。结果 40例患者TCH方案新辅助化疗6周期后ST-T改变、J点抬高、窦性心动过速、窦性心动过缓、房性早搏、室性早搏、房性心动过速、室性心动过速、房室传导阻滞、束支阻滞的发生率较化疗前无差别（P>0.05），心率、PR间期、QRS时限较化疗前亦无差别（P>0.05），化疗6周期后QTc间期较化疗前延长，差异具有统计学意义（P<0.05）。结论 TCH方案新辅助化疗可导致QTc间期延长，QTc间期可以作为TCH化疗方案早期心电损伤及心脏毒性的预测指标。

【关键词】TCH方案新辅助化疗;乳腺癌;心电图;QTc间期

[Abstract] Objective To analyze the ECG changes of HER2 positive breast cancer patients before and after neoadjuvant chemotherapy with TCH regimen， and to explore the toxic effect of neoadjuvant chemotherapy with TCH regimen on cardiac electrical activity. Methods The clinical data of 40 patients with HER2 positive breast cancer who were hospitalized in our hospital from January 2020 to December 2020 and received 6 cycles of neoadjuvant chemotherapy with TCH regimen before operation were retrospectively analyzed. Results The incidence of ST-T change， J point elevation， sinus tachycardia， sinus bradycardia， atrial premature beat， ventricular premature beat， atrial tachycardia， ventricular tachycardia， atrioventricular conduction block and bundle branch block in 40 patients after 6 cycles of TCH scheme neoadjuvant chemotherapy showed no difference compared with that before chemotherapy（P>0.05）. There were no significant differences in heart rate， PR interval and QRS time compared with those before chemotherapy（P>0.05）. After 6 cycles of chemotherapy， QTc interval was longer than that before chemotherapy， with statistical significance （P<0.05）. Conclusion Neoadjuvant chemotherapy with TCH regimen can prolong QTc interval. QTc interval can be used as a predictor of early electrocardiographic injury and cardiotoxicity.

Key words： TCH neoadjuvant chemotherapy; breast cancer; electrocardiogram;QTc interval

《全球疾病負担研究报告2017》指出全球73.4%的死亡由慢性非传染性疾病所致，其中心脑血管疾病、肿瘤和慢性呼吸系统疾病分别位列前3位。随着医疗水平的提高，越来越多的肿瘤患者生存期明显延长，与此同时随之而来的心血管疾病风险也在明显增加，尤其是乳腺癌、肺/支气管癌、多发性骨髓瘤和非霍奇金淋巴瘤的患者。HER-2阳性乳腺癌在乳腺癌中约占25%一30%，其浸润性强，无瘤生存率和总体生存率低，发现时多为Ⅱ、Ⅲ期，而新辅助化疗是Ⅱ、Ⅲ期乳腺癌的标准治疗方案之一，其可以缩小瘤体使肿瘤降期以手术根治，减少手术中的微小转移。……