ROLE OF MYOCARDIAL BIOPSY IN THE DIAGNOSIS OF ANTHRACYCLINE TOXICITY

肌内膜组织的光镜和电镜检查 通过导管活检从室间隔右侧获得 构成了一个有用的和准确的技术来评估程度 由于服用抗心律失常药物而产生的心脏毒性 蒽环类药物。 这些试剂产生特征性的 心肌病变，其中两个主要组成部分是可识别的： 肌原纤维损失和细胞质空泡化，由于扩张的 肌浆网 当毒性最小时，这些变化会影响 只有一小部分的肌细胞;由于毒性的严重性， 增加时，受影响的肌细胞百分比逐渐增加。 因此，半定量量表（比灵厄姆量表）已被 这些变化的等级从0到3+。 分级 已发现评分与总累积剂量相关， 蒽环类药物，并与心脏功能损害的程度。高 已经发现得分与风险因素相关， 蒽环类累积剂量超过550 mg/m2，高龄 （> 70岁），全身性动脉高血压，存在 其他心血管疾病和既往放射治疗 纵隔 在有这些危险因素的患者中，通过心脏监测 建议进行活检以指导蒽环类药物治疗， 经验剂量限制。

Light and electron microscopic examination of endomyocardial tissue obtained by catheter biopsy from the right side of the ventricular septum constitutes an useful and accurate technique for evaluating the degree of cardiac toxicity produced by the administration of antineoplastic agents of the anthracycline family. These agents produce characteristic myocardial lesions, in which two main components are recognizable: myofibrillar loss and cytoplasmic vacuolization due to dilatation of the sarcoplasmic reticulum. When toxicity is minimal, these changes affect only a small percentage of the myocytes; as the severity of the toxicity increases, a progressively larger percentage of myocytes is affected. Accordingly, a semi-quantitative scale (Billingham scale) has been devised in which these changes are graded from 0 to 3+. The grading score has been found to correlate with the total cumulative dose of the anthracycline, and with the extent of cardiac functional impairment. High scores have been found to be associated with risk factors such as cumulative doses of anthracyclines in excess of 550 mg/m2, advanced age (> than 70 years of age), systemic arterial hypertension, presence of other cardiovascular diseases, and previous radiotherapy to the mediastinum. In patients with these risk factors, monitoring by cardiac biopsy is recommended to guide therapy with anthracyclines beyond the empirical dose limitations.