注射用重组人白介素-11所致心脏毒性的临床观察

Clinical observation of cardiotoxicity induced by recombinant human interleukin-11 for injection

目的探讨恶性血液病患者化疗后使用注射用重组人白介素-11对心脏毒性的影响。方法 32例恶性血液病患者化疗后血常规检查BPC≤20×109/L或BPC≥20×109/L但有明显的出血改变时即予rhIL-11,治疗期间,如血常规检查BPC≥20×109/L且无明显的出血改变,即终止应用,动态观察rhIL-11使用后出现心脏毒性的平均时间及使用前后心电图、心脏彩超、心肌酶、肌钙蛋白Ⅰ、脑钠肽(BNP)、CRP及血压变化。结果使用rhIL-11后出现心脏毒性的中位时间为3.6 d,心电图表现为心律失常,以房性为主,房颤14例、房早12例、室早6例,其中18例伴有ST-T改变,心脏超声提示各瓣膜结构和EF值无变化。CK、CK-MB、AST、CRP、LDH用药前后比较差异有统计学意义(P<0.05)。CTnI均阴性,而BNP仅轻度升高(P>0.05)。使用前血压为(129±10/76±8)mmHg,使用后血压为(102±11/71±7)mmHg,用药前后比较差异有统计学意义(P<0.05)。结论应用rhIL-11出现心脏毒性可逆,不影响下次化疗时间,患者可以耐受,但使用过程中应当给予心电监护,定期复查心电图,高度关注心脏相关症状和体征,并及时予以对症治疗。

Objective To discuss the effect of cardiotoxicity induced by recombinant human interleukin-11 for injection after chemotherapy in malignant hematopathy patients.Methods 32 patients used rhIL-11 if the count of platelets≤20 × 109/L,or platelets≥20 × 109/L but hemorrhage obviously,during the treatment,rhIL-11 was terminated when the count of platelets≥20 × 109/L and had no change of bleeding.The average time of emerging cardiotoxicity,and the variety of electrocardiogram,color doppler echocardiography,myocardial enzymes,cardiac troponin Ⅰ,brain natriuretic peptide,c-reactive protein and blood pressure by dynamic were observed after use of rhIL-11.Results The median time appearing cardiotoxicity was 3.6 days after using rhIL-11.Arrhythmia was observed by electrocardiogram,especially atrial arrhythmia,atrial fibrillation accounted for 14 cases,atrial premature beats accounted for 12 cases,ventricular premature beat 6 cases,and 18 cases companion of ST-T alteration,echocardiography had no change.Compared with using rhIL-11 formerly,CK,CK-MB,AST,CRP,LDH had significant difference by using rhIL-11（P〈0.05）,CTnI were all negative,but BNP rose mildly（P〉0.05）.Blood pressure was（129 ± 10 /76 ± 8） mmHg without using rhIL-11,but the count was（102 ± 11 /71 ± 7） mmHg after using rhIL-11.The change of blood pressure had significant difference before and after treatment（P〈0.05）.Conclusion Cardiotoxicity which caused by using rhIL-11 could be reversed,has no effect with next chemotherapy,and could be endured by patients.But it needs to give ECG monitoring,reexamine ECG regularly,pays particular attention to symptoms and sign relating to heart,and treats symptoms timely in the process of using rhIL-11.