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目的探讨常规剂量三氧化二砷(As2O3)对急性早幼粒细胞白血病(APL)患者的心脏副作用。方法通过对52例成人急性早幼粒细胞白血病患者146例次砷剂治疗过程中的临床症状,心电图改变、心肌酶、年龄、联合化疗方案合用、累积剂量、用药方法等的回顾调查,分析三氧化二砷治疗相关性心脏副作用的发生规律和影响因素。结果146例次砷剂治疗中心脏症状发生率22.6%,心肌酶异常发生率1.3%,ECG异常发生率63.0%。50~60岁人群的治疗相关心脏事件发生率最高(82.8%,P<0.05),合并传统化疗比砷剂单药的心脏事件发生率高(P<0.05)。间歇用药比连续用药的ECG异常发生率低(44.7%对66.2%,P<0.05)。累积剂量达1000 mg时心脏不良事件发生率达高峰。低钾血症是加重心脏毒副作用的因素之一。结论常规剂量的三氧化二砷治疗APL有一定的心脏毒副作用,在临床上应引起注意。
Objective To investigate the side effects of conventional arsenic trioxide (As2O3) on acute promyelocytic leukemia (APL). Methods A retrospective investigation of clinical symptoms, electrocardiogram changes, myocardial enzymes, age, combined chemotherapy regimen, cumulative dose and medication method was performed in 146 cases of arsenic in the treatment of acute promyelocytic leukemia in 52 adults. Arsenic trioxide The incidence and influencing factors of heart related side effects. Results 146 cases of arsenic agents in the treatment of heart disease incidence of 22.6%, abnormal myocardial enzyme incidence of 1.3%, 63% of ECG abnormalities. The incidence of treatment-related cardiac events was highest in people aged 50-60 years (82.8%, P <0.05), and the incidence of cardiac events was higher in patients with conventional chemotherapy than in those with arsenic alone (P <0.05). The incidence of ECG abnormalities was lower for intermittent medication than for continuous medication (44.7% vs 66.2%, P <0.05). Cardiac adverse events peaked at a cumulative dose of 1000 mg. Hypokalemia is one of the factors that aggravate the side effects of heart. Conclusion Conventional doses of arsenic trioxide in the treatment of APL have some side effects of heart and should be noticed clinically.