含表柔比星化疗方案对乳腺癌患者早期心脏毒性的影响因素

Influence factors for early cardiac toxicity in patients with breast cancer undergoing chemotherapy with epirubicin regimens

目的分析含表柔比星(EPI)化疗方案对乳腺癌患者早期心脏毒性的影响因素。方法乳腺癌患者232例予含EPI(60-100mg·m-2·d-1)为主的方案辅助化疗,每21天为1个周期,共4-8个周期。常规十二导联心电图监测患者心电图变化;单因素及多因素分析乳腺癌患者心脏毒性的相关因素。结果心电图异常发生率为20.3%(47/232)。基础疾病与心电图异常呈正相关(P<0.05),无基础疾病202例患者中,EPI累积剂量≥500mg/m2患者心电图异常率高于EPI累积剂量<500mg/m2患者(26.3%vs.12.7%)(P<0.05);EPI累积剂量≥500mg/m2患者中,年龄≥55岁患者心电图异常率高于年龄<55岁患者(45.0%vs.19.6%)(P<0.05);年龄≥55岁患者中,EPI累积剂量≥500mg/m2患者的心电图异常率高于EPI累积剂量<500mg/m2患者(45.0%vs.14.3%)(P<0.05)。年龄≥55岁、EPI累积剂量≥500mg/m2和基础疾病是乳腺癌患者出现心脏毒性的独立相关因素(P<0.05)。结论含EPI方案化疗所致的乳腺癌患者早期心脏毒性与年龄≥55岁、EPI累积剂量≥500mg/m2和基础疾病密切相关。

Objective To analyze the influence factors for early cardiac toxicity in patients with breast cancer undergoing chemotherapy with epirubicin regimens. Methods A total of 232 patients with breast cancer was treated with epirubicin 60-100 mg · m2 · d-1 for 4-8 cycles（21 days one cycle）. Abnormal changes of ECG were monitored with general 12-lead ECG and the cardiac toxicity-related factors were evaluated with univariate and multivariate analysis. Results The incidence of abnormal ECG was 20.3% （47/232）. Underlying diseases were positively correlated with abnormal ECG changes（P〈0. 05）. Among 202 patients without underlying diseases, the incidence of abnormal ECG in the patients with accumulated dose of epirubicin ≥500 mg/mz was higher than that in those with accumulated dose of epirubicin〈500 mg/m2 （26.3% vs. 12. 7%） （P〈0. 05）. Among 76 patients with accumulated dose of epirubicin ≥500 rng/m2 , but without underlying disease, the incidence o{ abnormal ECG in the patients aged ≥55 years old was higher than that in those aged 〈55 years old （45.0% vs. 19.6%）（P〈0. 05）. Among 69 patients aged ≥55 years old without underlying diseases, the incidence of abnormal ECG in the patients with accumulated dose of epirubicin 〉/500 mg/m2 was higher than that in those with accumulated dose of epirubicin 〈 500 mg/m2 （45.0% vs. 14.3%） （P〈0. 05）. Age ≥55 years old,accumulated dose of epirubicin≥500 mg/m2 and underlying diseases were the independent factors for cardiac toxicity （P〈0. 05）. Conclusion Age ≥ 55 years old, accumulated dose of epirubicin 9500 mg/mz and underlying diseases are closely related with early cardiac toxicity in the patients with breast cancer undergoing chemotherapy with epirubicia regimens.