NT-proBNP与GPBB对蒽环类药物致心脏毒性的早期监测

Early detection of NT-proBNP and GPBB for cardiotoxicity induced by anthracycline in patients with mammary cancer

目的:探讨N-端脑钠肽前体(NT-proBNP)与糖原磷酸化酶BB型同功酶(GPBB)对蒽环类药物致心脏毒性的早期监测及临床意义。方法:选取住院女性乳腺癌术后应用蒽环类药物化疗的患者50例,在化疗前、第1个疗程结束、第2个疗程结束及化疗结束4个时间点进行心电图及超声心动图监测,并采血测量NT-proB-NP、GPBB、血肌酐(SCr)及磷酸激酶同工酶(CK-MB)水平的变化。结果:NT-proBNP与GPBB最早出现异常,第1、2个疗程结束及化疗结束时其水平与化疗前比较均差异有统计学意义(均P<0.01),SCr及CK-MB水平在化疗结束时与化疗前比较差异有统计学意义(均P<0.01)。心电图异常主要表现为窦性心动过缓、T波低平、ST段下降及QT间期延长,随化疗时间的延长,心电图异常的发生率有逐渐下降趋势。左心室射血分数(LVEF)随化疗时间的延长逐渐降低,其水平在化疗结束时与化疗前相比差异有统计学意义(P<0.05)。结论:NT-proBNP与GPBB可作为早期监测蒽环类药物致心脏毒性的敏感指标,在化疗过程中有重要的临床意义。

Objective：To explore the early detection significance of NT-proBNP and GPBB in cardiotoxicity induced by anthracycline chemotherapy in patients with mammary cancer.Method：Fifty patients with mammary cancer were examed by ECG and UCG,and levels of NT-proBNP,GPBB,SCr and CK-MB were tested at four time-points：before,end of first course,end of second course and end of all course chemotherapy.Result：Com- pared with before chemotherapy,the levels of NT-proBNP and GPBB at the end of first course,end of second course and end of all course were gradually increased（all P〈0.01）,while levels of SCr and CK-MB at end of all course chemotherapy were increased （all P〈0.01）.Abnormal of ECG mainly characterized by sinus heartbeat bradycardia,lowering of T wave,ST segment depression and prolongation of QT interval,and the incidence of ECG abnormalities was gradually declined with the prolongation of chemotherapy time.LVEF was declined with the prolongation of chemotherapy time too,and it was statistically decreased at the end of all course compared with before chemotherapy（P〈0.05）.Conclusion：NT-proBNP and GPBB can be used as sensitive indicators for cardio- toxicity induced by anthracycline chemotherapy in patients with mammary cancer.