Ventricular repolarization dynamics in arsenic trioxide treatment of acute promyelocytic leukemia
Ventricular repolarization dynamics in arsenic trioxide treatment of acute promyelocytic leukemia
复制标题
三氧化二砷治疗急性早幼粒细胞白血病的心室复极动态
DOI：
10.1016/j.ijcard.2019.11.099
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发表时间：
2020
影响因子：
3.5
通讯作者：
Li Dengju
中科院分区：
文献类型：
--
作者：
Sun Yinan;Wang Lu;Que Yimei;Zhu Hongling;Yang Xiaoyun;Li Dengju
研究背景三氧化二砷是急性早幼粒细胞白血病（APL）的一线治疗药物，但其最常见的不良反应是心室复极异常和QT间期延长。目的探讨APL患者在三氧化二砷诱导治疗过程中心室复极的动态变化及临床因素的影响。统计分析三氧化二砷对心室复极相关指标如QTc、QT间期离散度（QTd）、心率校正J至T峰（JTpC）和T峰至T末协变量（TpTec）间期的影响。进一步进行Logistic回归分析，探讨各种临床因素与复极指标变化的相关性。三氧化二砷治疗后QTc > 500 ms的7例患者退出研究。QTc、QTd和JTpC间期在第8天延长; TpTec在诱导后期延长。危险因素包括疾病危险度、血红蛋白和乳酸脱氢酶对QTc的影响，血红蛋白对QTd的影响，疾病危险度和血红蛋白对JTpC和TpTec的影响。低凝血酶血症是APL患者心室复极延长的常见危险因素，在预防三氧化二砷的心脏不良反应时应予以考虑。
BackgroundArsenic trioxide is the first-line treatment for acute promyelocytic leukemia (APL); however, abnormalities of ventricular repolarization and QT interval prolongation are the most common adverse effects. We explore ventricular repolarization dynamic changes and the influence of clinical factors in APL patients during arsenic trioxide induction therapy.MethodsAPL patients receiving arsenic trioxide induction therapy were included. Arsenic trioxide effects on ventricular repolarization-related indicators such as QTc, QT interval dispersion (QTd), heart rate-corrected J to T-peak (JTpC), and T-peak to T-end covariate (TpTec) interphase were statistically analyzed. Furthermore, logistic regression analysis was conducted to explore the correlation between various clinical factors and changes in repolarization indexes.ResultsNinety-three patients were recruited finally. Seven patients with QTc > 500 ms after arsenic trioxide treatment were discontinued from the study. QTc, QTd and JTpC interphase prolonged on day 8; TpTec prolongation was observed at the late induction stage. The risk factors were disease risk, hemoglobin and lactate dehydrogenase for QTc; hemoglobin for QTd; disease risk and hemoglobin for JTpC and TpTec.ConclusionQTc, QTd and JTpC were prolonged in the early use of arsenic trioxide and in contrast with TpTec. Hypothrombinemia was a common risk factor of ventricular repolarization prolongation and should be considered in preventing cardiac adverse effects of arsenic trioxide in APL patients.