目的：研究临床、物理因素对胸部癌症患者三维放疗后急性放射性心脏损伤（ RIHD）发生的影响。方法对212例胸部恶性肿瘤患者，采用瓦里安21EX型加速器进行三维适形、调强放疗，在放射治疗前后、放射治疗90天内分别检测患者的心脏损伤情况，应用NCI-CTCAE3．0版对急性放射性心脏分级标准评价。采用单因素分析临床、物理因素与心脏损伤的关系。结果放射治疗后，患者的心电图、肌钙蛋白、心肌酶谱、心包积液异常发生率分别为67．5％、10．9％、13．7％、6．6％。临床因素均不是急性放射性心脏损伤发生的影响因素，物理因素中心脏Dmax、V60是放射性心脏损伤发生的影响因素。结论胸部肿瘤放射后心脏的损伤以心电图异常较为常见，其中心脏Dmax、V60是放射性心脏损伤发生的影响因素。%Objective To study the influence of clinical and physical factors on acute radiation-induced heart disease ( RIHD) of breast cancer patients treated with three-dimensional radiotherapy .Methods 212 cases of patients with breast cancer received three-dimensional conformal intensity modulated radiation therapy ( imrt ) using varian 21EX type accelerator .The patient's heart damage was detected in before and 90 days after radiotherapy ,acute RIHD classified by NCI -CTCAE3.0 version. Relation among RIHD and clinical and physical facotrs was studied by single factor analysis .Results After radiotherapy ,inci-dence of abnormal electrocardiogram , troponin, myocardial enzyme spectrum , and pericardial effusion were 67.5%, 10.9%, 13.7%and 6.6%,respectively.Clinical factors were not factors affecting acute RIHD ,and Dmax、V60 in physical factors were in-fluence factors for acute RIHD .Conclusion Abnormal electrocardiogram is the common RIHD in breast cancer patients after ra-diotherapy,and Dmax、V60 are the influence factors for RIHD.
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