吡柔比星化疗所致心脏毒性的早期监测与防治

Early detection of the cardiotoxicity induced by theprubicin chemotherapy

目的:应用超声心动图观察右丙亚胺对吡喃阿霉素(吡柔比星,THP)所致心脏毒性的防治作用。方法:将接受吡柔比星化疗的非霍奇金淋巴瘤患者30例随机分为单纯化疗组及右丙亚胺组各15例,右丙亚胺组在常规化疗基础上,加用右丙亚胺静滴。在化疗第1疗程(T1)开始前、第3疗程(T3)及第6疗程(T6)结束后行超声心动图检测,记录EF、E/A及TDI技术测量E'/A'、PW/PW法测量Tei指数,观察化疗前后吡柔比星对上述指标的影响,以及右丙亚胺对其心脏毒性的防治效果。结果:组间比较,T3结束后,单纯化疗组及右丙亚胺组EF及E/A差异无统计学意义(P>0.05),E'/A'及Tei指数有统计学意义(P<0.05)。T6结束后,单纯化疗组及右丙亚胺组EF及E/A差异存在统计学意义(P<0.05),E'/A'及Tei指数亦存在有统计学意义(P<0.05)。组内比较,与T1比较,单纯化疗组在T3结束后EF及E/A差异无统计学意义(P>0.05),而E'/A'及Tei指数有统计学意义(P<0.05),在T6结束后,单纯化疗组与T1比较,其EF、E/A、E'/A'及Tei指数均存在统计学意义(P<0.05);右丙亚胺组在T3、T6结束后,与T1比较,其EF、E/A、E'/A'及Tei指数的差异均无统计学意义(P>0.05)。结论:右丙亚胺对吡柔比星化疗所致的心脏毒性具有一定的防治作用,TDI及Tei指数能够较EF及E/A更早、更敏感评估患者心脏功能的变化。

Objective：Evaluated the prevention role for cardiotoxicity induced by theprubicin chemotherapy and dexrazoxane. Methods：Thirty nonlymphocytic leukemia patients undergoing a 6 - cycle chemotherapy regimen were divided into two groups：THP group （n=15,treated with thepubicin alone） and T - D group （n 15,treated combined with thepubicin and dexrazoxane）. Echocardiography study were performed on the first eyrie （T1）, middle （T3） ,and at the end （T6）. Results：Compared THP and T - D groups：After T3,there were significant differences in E＇/A＇ （decreased） and Tei index （pralonged） in THP group （P 〈0.05） ,but not in left veutride ejection fraction （EF） and E/A ration （P 〉 0.05）. After T6, significant differences were found on EF （decreased）, E/A （ decreased） ,E＇/A＇ （decreased） and Tei index （prolonged） in THP group （P 〈 0.05）. Before and after treatment ： after T3,E＇/A＇ and Tel index were significantly changed in THP group compared to T1 （P 〈 0.05）, but not in EF and E/A （P 〉0.05）. After T6,EF,E/A,E＇/A＇and Tel index were significant different in THP group（P 〈0.05）. After T3 and T6,there were no differences among EF, E/A, E＇/A＇ and Tel index in T - D group （P 〉 0.05）. Conclusion： Dexrazoxane can prevent theprubiein eardiotoxieity in nonlymphoeytie leukemia patients. E＇/A＇and Tel index may be the sensitive markers for detecting early theprubiein - induced eardiotoxieily.