淋巴瘤患者血浆脑钠肽与蒽环类药物心脏毒性的相关性研究

Study on correlation between brain natriuretic peptide and anthracyclin-induced cardiac toxicity in patients with lymphoma

目的 探讨淋巴瘤患者血浆中脑钠肽（BNP）与蒽环类药物心脏毒性的相关性。方法 选择使用蒽环类药物化疗后的36例淋巴瘤患者，分别在化疗前及蒽环类药物累积量达200、400mg/m2后，检测血浆脑钠肽及超声心动图各指标变化情况。结果 当蒽环类药物累积量达到200 、400mg/m2时，36例淋巴瘤患者血浆BNP水平为（292±6.71） ng/ml、（387±3.54）ng/ml较化疗前（134±5.87） ng/ml明显升高（P〈0.05），心室舒张功能指标（左室舒张期/收缩期充盈峰速度E/A）为1.14±0.37、0.90±0.06较化疗前1.33±0.27明显降低（P〈0.05），而收缩功能指标（射血分数EF、短轴缩短率FS）差异无统计学意义（P〉0.05）。当蒽环类药物累积量达到200、400mg/m2时，血浆BNP水平与E/A存在负相关（r值-0.689，p值0.042；r值-0.557，p值0.006），而与EF、FS不存在相关性（P〉0.05）。结论 BNP作为蒽环类药物化疗心脏毒性的早期监测指标有一定临床意义。

Abstract：[Objective] To evaluate the clinical correlation between brain natriuretic peptide （BNP） and anthracycline-induced cardiotoxicity. [Methods] Thirty-two adult patients with non-Hodgkin’s lymphoma, who received the treatment with chemotherapy including anthracyclin were studied. After the cumulative anthracyclin chemotherapeutic agents dose of 200 and 400 mg m-2, we investigate changes in plasma brain natriuretic peptide and echocardiography indices. [Results] After the cumulative anthracyclin chemotherapeutic agents doses of 200 and 400 mg m-2 serum brain natriuretic peptides were 292±6.71ng ml-1 and 387±3.54 ng ml-1 respectively ,which compared with the untreated（134±5.87 ng ml-1） significantly increased（P〈0.05）.And diastolic function parameters ratio of peak early to peak late ？ow velocities （E/A ratio）were 1.14±0.37、0.90±0.06,which compared with the untreated（1.33±0.27）decreased significantly（P〈0.05）.While systoli function parameters left ventricular ejection fraction（EF）and fractional shortening（FS）remained unchanged（P〉0.05）.After the cumulative anthracyclin chemotherapeutic agents dose of 200 and 400 mg m-2, signi？cant inverse correlations were observed between plasma brain natriuretic peptide and E/A ratio（r值-0.689,p值0.042;r值-0.557,p值0.006） but with no correlations between left ventricular ejection fraction and fractional shortening（P〉0.05）. [Conclusions] Plasma brain natriuretic peptide concentrations appear to provide a sensitive method for assessing early anthracycline-induced cardiotoxicity.