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目的探讨磷酸肌酸钠防治蒽环类药物所致儿童急性白血病(AL)急性心脏毒性的临床效果。方法选取80例AL患儿,随机分为观察组和对照组,每组40例。两组患儿均采用包含蒽环类药物的标准化疗方案,但观察组患儿在进行化疗时加用磷酸肌酸钠。两组患儿出现急性心脏毒性反应后停止蒽环类药物并采用磷酸肌酸钠治疗。监测两组患儿化疗期间磷酸肌酸激酶同工酶(CK-MB)水平、心肌肌钙蛋白阳性率、心电图、超声心动图等,并根据监测情况判断急性心脏毒性反应的发生情况。结果化疗期间,观察组患儿急性心脏毒性的发生率(2.5%)低于对照组患儿(20.0%),差异有统计学意义(P<0.05)。对照组患儿中出现CK-MB水平上升和心电图异常的患儿比例均高于观察组,差异均有统计学意义(均P<0.05)。确诊为急性心脏毒性反应的9例患儿采用磷酸肌酸钠治疗两周后,7例患儿的心肌损害症状完全消失,2例患儿的症状明显好转。结论采用蒽环类药物化疗的同时,使用磷酸肌酸钠可降低AL患儿出现急性心脏毒性反应的概率,并可改善已出现急性心脏毒性反应患儿的症状。
Objective To investigate the clinical efficacy of sodium creatine phosphate in the prevention and treatment of acute cardiotoxicity induced by anthracycline in children with acute leukemia (AL). Methods 80 cases of AL children were randomly divided into observation group and control group, 40 cases in each group. Both groups received standard chemotherapy with anthracyclines, but patients in the observation group also received sodium creatine phosphate during chemotherapy. Two groups of children with acute cardiotoxic reactions after stopping anthracycline and treatment with sodium creatine phosphate. The levels of creatine phosphokinase (CK-MB), cardiac troponin, electrocardiogram (ECG) and echocardiography during the chemotherapy were monitored in both groups. The occurrence of acute cardiotoxicity was evaluated according to the monitoring results. Results During the chemotherapy, the incidence of acute cardiotoxicity in the observation group was lower than that in the control group (2.5%) (20.0%, P <0.05). The proportion of children with CK-MB level rise and ECG abnormalities in the control group were higher than those in the observation group (all P <0.05). Nine children diagnosed with acute cardiotoxicity were treated with sodium creatine phosphate for two weeks, and the symptoms of myocardial damage in seven children disappeared completely, and the symptoms of two children were significantly improved. Conclusions Anthracycline chemotherapy, while using sodium creatine phosphate can reduce the incidence of AL in children with acute cardiotoxicity and improve the symptoms of children with acute cardiotoxicity.