卡铂、紫杉醇新辅助化疗对食管癌患者心脏功能的影响

Effects of carboplatin combined with paclitaxel in neoadjuvant chemotherapy on cardiac function of patients with esophageal cancer

目的观察卡铂、紫杉醇联合新辅助化疗对食管癌患者心脏功能的影响。方法 46例食管癌患者术前行卡铂联合紫杉醇新辅助化疗5周。每例患者化疗前后计数心率,测量收缩压及舒张压,检测血清肌酸激酶、肌酸激酶同工酶、脑钠肽和肌钙蛋白,心脏彩超检查测左心室收缩末容积、左心室舒张末容积、左心室射血分数、左心室容量、下腔静脉血流速度。对化疗后各指标变化行单因素Logistic回归分析,并计算变化值和95%可信区间(95%CI)。结果 46例食管癌患者接受卡铂联合紫杉醇联合新辅助化疗5周后收缩压平均下降18 mm Hg,95%CI为(-25,-10),P<0.05;舒张压平均下降6 mm Hg,95%CI为(-14,-2),P<0.05;心率平均增加5次/min,95%CI为(1,11),P<0.05;肌钙蛋白平均升高0.008 mmol/L,95%CI为(-0.002,-0.012),P<0.05;肌酸激酶平均升高42 IU/L,95%CI为(18,71),P<0.05;左心室容量平均下降54 m L,95%CI为(-72,-39),P<0.05。结论接受卡铂、紫杉醇联合新辅助化疗的食管癌患者,血清心肌肌酸激酶上升,收缩压及舒张压降低,心室容量变小。

Objective To evaluate the effects of carboplatin combined with paclitaxel during neoadjuvant chemotherapy on cardiac function of patients with esophageal cancer. Methods Totally 46 patients with esophageal cancer received the neoadjuvant chemotherapy with carboplatin and paclitaxel for 5 weeks before the operation. We recorded the heart rate,measured the systolic blood pressure and diastolic blood pressure,detected the blood creatine kinase,creatine kinase isoenzyme,brain natriuretic peptide and troponin,and examined the left ventricular end-systolic volume,left ventricular end-diastolic volume,left ventricular ejection fraction,ventricular volume and blood flow velocity of inferior vena cava before and after chemotherapy. Univariate Logistic regression analysis was conducted on the index changes after chemotherapy,and the change value and 95% confidence interval（ 95% CI） were calculated. Results After 46 patients with esophageal cancer received the neoadjuvant chemotherapy with carboplatin and paclitaxel for 5 weeks,the systolic blood pressure dropped an average of 18 mm Hg,95% CI（ 25,- 10）,P 0. 05; diastolic blood pressure dropped an average of 6 mm Hg,95% CI（- 14,- 2）,P 0. 05; the heart rate increased an average of 5 / min,95% CI（ 1,11）,P 0. 05; troponin increased an average of 0. 008 mmol / L,95% CI（- 0. 002,- 0. 012）,P 0. 05; creatine kinase increased an average of 42 IU / L,95% CI（ 18,71）,P 0. 05; and ventricular volume dropped an average of 54 m L,95% CI（- 72,- 39）,P 0. 05. No significant differences were found in the rest of indexes before and after surgery. Conclusion The myocardial creatine kinase increased,systolic blood pressure and diastolic blood pressure decreased and the ventricular size became smaller in patients with esophageal cancer receiving neoadjuvant chemotherapy of carboplatin and paclitaxel.