表阿霉素复合药物对乳腺癌患者血管内皮功能与左心室舒张功能的影响

Effects of epirubicin on endothelial and left ventricular diastolic function in breast cancer patients

目的：通过高频超声评价表阿霉素（ Epi）复合药物对乳腺癌患者血管内皮功能与左心室舒张功能的影响及两者的相关性。方法140例乳腺癌患者分为3组：A组为对照组40例，未给予化疗。B组50例，采用以Epi为主的化疗方案（环磷酰胺＋Epi＋5－氟尿嘧啶），Epi累积剂量180～240 mg／m2；C组50例，同B组化疗方案且Epi≥360 mg／m2。检测3组患者内皮依赖性及内皮非依赖性舒张功能，比较其肱动脉内径变化。在QTVI条件下测量二尖瓣环平均舒张期峰值速度（Ve）、计算两个位点平均峰值速度及E／Ve。结果（1）与A组比较，B组肱动脉内皮依赖性舒张功能（ EDD）减低不明显，两组比较差异无显著性意义（ P＞0．05），C组EDD明显减低，与A组、B组间比较差异均有显著性意义（P＜0．05）。与A组比较，B组、C组肱动脉内皮非依赖性舒张功能（NEDD）均减低，但3组间比较差异无显著性意义（P＞0．05）。（2）与A组比较，B组Ve减低不明显，E／Ve增高不明显，两组比较差异无显著性意义（P＞0．05），C组Ve明显减低，E／Ve明显增高，与A组、B组间比较差异均有显著性意义（P＜0．05）。（3）EDD与Ve呈正相关，与E／Ve呈负相关。 NEDD与Ve、E／Ve均不相关。结论乳腺癌患者使用较大剂量Epi复合药物治疗时，其血管内皮功能变化与左心室舒张功能的改变密切相关。

Objective To study the effects of epirubicin （ Epi） on vascular endothelial and left ventricular diastolic func-tion in breast cancer patients by high frequency ultrasound.Methods Totally 140 breast cancer patients were divided into three groups based on Epi chemotherapy （ cyclophosphamide＋Epi＋5-fluorouracil） , including 40 patients without chemo-therapy after surging as the control group （ group A） .Fifty patients in group B were given Epi of 180~240 mg/m2 .Fifty patients in group C were given Epi of≥360 mg/m2 .Endothelial dependent dilation （ EDD） and non-endothelial depend-ent dilation （ NEDD） were calculated and the inner diameter changes of the brachial artery were compared among three groups.Peak diastolic velocity （ Ve） at the mitral annulus were measured by QTVI and average peak velocity of two sites and E/Ve were calculated.Results （ 1 ） The difference of EDD between group A and group B was not significant （ P〉0.05）.But the EDD in group C was obviously lower and had significant difference compared to group A and group B （both P〈0.05）.Compare to group A,the NEDD in group B and group C were lower although the difference was not significant among three groups （P〉0.05）.（2）The difference of Ve and E/Ve between group A and group B was not significant （P〉0.05）.But the Ve was obviously lower and the E/Ve was obviously higher in group C compared to group A and group B （both P〈0.05）.（3）The E/Ve was negatively correlated with EDD;whereas the Ve was positively correlated with EDD （P〈0.05）.However, both E/Ve and Ve were uncorrelated with NEDD （P〉0.05）.Conclusion In breast cancer pa-tients treated with large dose of Epi, the changes between vascular endothelial function and Left Ventricular Diastolic Func-tion are closely related.