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目的观察治疗剂量的三氧化二砷(As2O3)对急性早幼粒细胞白血病(APL)患儿的心脏毒性。方法对37例APL患儿静脉滴注As2O3进行心脏毒性监测,观察患儿临床表现、心电图(ECG)、心肌酶谱(LDH、α-HBDH、CK、CK-MB、CK-MBMass和cTnI)、心脏扇扫超声、24h动态ECG等变化。结果 APL患儿37例中,5例(13.5%)诱导缓解期出现心悸、心前区不适,均在3周后消失,无明显心前区憋闷、钝痛等。未见明显ECG变化;与治疗前比较,cTnI和CK-MBMass在第2周、第3周均明显升高(Pa<0.01),CK-MBMass在第4周仍明显升高(P<0.05)。CK-MB在第2周开始显著升高(P<0.05),第3周达到高峰,之后逐渐下降。治疗前后CK、LDH和α-HBDH呈逐渐下降趋势,3周后均恢复正常;其中29例心脏扇扫超声均未发现异常;27例完全缓解超过2a者中,18例(66.7%)进行了24h动态ECG检查:4例(22.2%)有ST-T波异常。结论常规剂量As2O3治疗小儿APL心脏毒性较轻,安全可靠。As2O3累积量的变化对小儿心肌的近期影响不大,自觉症状不明显,动态检测CK-MB、cTnI和CK-MBMass变化可以早期发现砷剂的心肌损害。而24h动态ECG检查更易发现其早期电学变化。
Objective To investigate the cardiotoxicity of arsenic trioxide (As2O3) in children with acute promyelocytic leukemia (APL) at a therapeutic dose. Methods 37 cases of APL were infused intravenously with As2O3 for cardiotoxicity monitoring. The clinical manifestations, electrocardiogram (ECG), myocardial enzymes (LDH, CK-MB, CK, MB, CK-MBMass and cTnI) Heart swept ultrasound, 24h dynamic ECG changes. Results Among 37 APL children, 5 cases (13.5%) had heart palpitations and precordial discomfort during the induction remission, all disappeared after 3 weeks. There was no significant change of ECG. Compared with before treatment, cTnI and CK-MBMass were significantly increased in the second week and the third week (Pa <0.01), CK-MBMass still significantly increased in the fourth week (P <0.05) . CK-MB began to significantly increase from the second week (P <0.05), peaked at the third week, and then gradually decreased. Before and after treatment, CK, LDH and α-HBDH showed a gradual downward trend and returned to normal after 3 weeks. Of the 29 cases, no abnormality was found in 29 cases of echocardiography; among 27 patients with complete remission over 2 years, 18 cases (66.7% ECG examination: 4 cases (22.2%) had ST-T wave abnormalities. Conclusion The conventional dose of As2O3 treatment of children with APL heart toxicity, safe and reliable. The change of As2O3 accumulation has little effect on the myocardial infaction in the short term, and the subjective symptoms are not obvious. Dynamic changes of CK-MB, cTnI and CK-MBMass can detect myocardial damage of arsenic agents early. 24h dynamic ECG examination is more likely to find its early electrical changes.