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目的探讨鼻咽癌患者放射治疗后动态心电图、QT离散度和心率变异性(HRV)的变化情况。方法对40例鼻咽癌患者治疗前及接受3个阶段不同放射剂量(分别为15~25 Gy、35~45 Gy和55~65 Gy)的放射治疗后(每一个治疗阶段均行动态心电图监测),观察放射治疗致心电图及QT离散度(QTd)、校正后QT离散度(QTcd)和HRV时域指标及频域指标改变的情况。结果鼻咽癌患者放疗前和3个阶段放射治疗后动态心电图各项指标比较:(1)室上性心律失常、室性心律失常和ST-T改变的发生率比较,差异均无统计学意义(P>0.05);(2)QTd、QTcd指标比较,差异均无统计学意义(P>0.05);(3)HRV分析比较,1时域指标SDNN、rMSSD、pNN50差异均无统计学意义(P>0.05);2频域指标TP、LF、HF、LF/HF差异均无统计学意义(P>0.05);两两比较后,VLF在3个阶段放射治疗后显著低于放疗前,差异有统计学意义(P<0.05)。结论 (1)室性心律失常和ST-T改变的发生率的变化趋势相似,即放射剂量为15~25 Gy时呈上升趋势、35~45 Gy时呈下降趋势、55~65 Gy时呈明显上升趋势;(2)QTd、QTcd指标在放射剂量为15~25 Gy时呈下降趋势、35~45 Gy时呈上升趋势、55~65 Gy时恢复到治疗前水平;(3)HRV指标中,随着放射剂量的增加,VLF的降低更加显著,提示鼻咽癌患者放疗后影响了体温调节、肾素血管紧张素系统及体液因子等因素的长期调节,引起交感神经活动增强,影响交感-迷走神经之间的均衡性,从而影响自主神经调节,导致心电图异常。
Objective To investigate the changes of dynamic electrocardiogram, QT dispersion and heart rate variability (HRV) after radiotherapy in patients with nasopharyngeal carcinoma. Methods Forty patients with nasopharyngeal carcinoma before radiotherapy and three radiotherapy doses (15 ~ 25 Gy, 35 ~ 45 Gy and 55 ~ 65 Gy, respectively) were enrolled in this study. ), ECG and QT dispersion induced by radiotherapy (QTd), corrected QT dispersion (QTcd) and HRV time domain and frequency domain indexes were observed. Results Before and after radiotherapy of nasopharyngeal carcinoma, the indexes of electrocardiogram after radiotherapy were compared: (1) The incidence of supraventricular arrhythmias, ventricular arrhythmias and ST-T changes were not statistically significant (P> 0.05). (2) There was no significant difference between QTd and QTcd indicators (P> 0.05). (3) Compared with HRV analysis, there was no significant difference in SDNN, rMSSD and pNN50 (P> 0.05). There was no significant difference in the 2-band indices of TP, LF, HF and LF / HF between the two groups (P> 0.05) There was statistical significance (P <0.05). Conclusions (1) The changes of ventricular arrhythmia and ST-T changes are similar, that is, the radiation dose is in the range of 15 ~ 25 Gy, while it decreases in the range of 35 ~ 45 Gy, and obviously in the range of 55 ~ 65 Gy (2) The QTd and QTcd indexes showed a decreasing trend at the dose of 15 ~ 25 Gy, the rising trend at 35 ~ 45 Gy and the level of pretreatment before 55 ~ 65 Gy. (3) In the HRV index, With the increase of radiation dose, the decrease of VLF is more significant, which indicates that the long-term regulation of body temperature regulation, renin-angiotensin system and humoral factors after radiotherapy affect the long-term regulation of sympathetic nerve activity and influence the sympathetic-vagus nerve The balance between, thus affecting autonomic regulation, leading to abnormal ECG.