心肌生化标志物联合检测评价重组人血管内皮抑素心脏毒性

Assessment of the cardiotoxicity of recombinant human endostatin using myocardial biochemical markers in cancer patients

目的评价肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)和N端B型脑钠肽(NT-proBNP)三种心肌生化标志物以及心电图在监测重组人血管内皮抑素心脏毒性中的临床意义。方法将48例恶性肿瘤患者分成两组,A组(24例)重组人血管内皮抑素联合化疗,B组(24例)单纯化疗,每治疗周期的d0、d15检测心电图,以及血清CK-MB、cTnT和血浆中NT-proBNP水平,共观察2个治疗周期。结果A组每个治疗周期结束后CK-MB,cTnT和NT-proBNP与治疗前基线相比明显升高(P<0.05),B组组内比较则无统计学差异(P>0.05);两组治疗前(基线)CK-MB,cTnT和NT-proBNP水平无统计学差异(P>0.05),每个周期治疗后A组CK-MB,cTnT和NT-proBNP水平与B组相比均有明显升高,有统计学差异(P<0.05)。A组组内不同治疗时间心电图异常率比较有统计学差异(P<0.05),第二周期治疗后心电图异常率两组相比有统计学差异(P<0.05)。结论重组人血管内皮抑素存在确切的心脏毒性。CK-MB、cTnT和NT-proBNP可作为预测重组人血管内皮抑素心脏毒性的心肌生化标志物。

Objective To evaluate the value of the myocardial biochemical markers including creatine kinase MB isoenzyme （CK-MB）, cardiac isoform of Tropnin-T （cTnT） and N-termimal pro-brain natriuretic peptide （NT-proBNP） and electrocardiogram （ECG） in monitoring the cardiotoxicity of recombinant human endostatin （rh-endostatin） in cancer patients, Methods Forty cancer patients were divided into two groups and received rh-endostatin in addition to chemotherapy （group A, n=24） or chemotherapy only （Group B, n=24）. Serum CK-MB, cTnT levels and plasma NT-proBNP levels were measured and the ECG was recorded in all the patients before and after each of the two therapy cycles. Results In group A, serum CK-MB, cTnT and plasma NT-proBNP levels were significantly increased after the treatment in comparison with the baseline levels （P〈0.05）, but such increment was not observed in group B （P〉0.05）. With comparable baseline levels of CK-MB, cTnT and NT-proBNP before the treatment （P〉0.05）, patients in group A showed significantly higher levels of the indices than those in group B after each therapy cycle （P〈0.05）. Increased ECG abnormality were observed after rh-endostatin treatment in Group A （P〈0.05） at a rate significantly higher than that of Group B after the second treatment cycle （P〈0,05）. Conclusion Rh-endostatin has definite cardiotoxicity, and detection of the myocardial biochemical markers of CK-MB, cTnT and lbrr-proBNP may help predict the occurrence of cardiotoxicity.