心脉隆注射液对曲妥珠单抗和蒽环类药物序贯化疗乳腺癌患者致心脏毒性气虚血瘀证的保护作用

Protection Effect of Xinmailong Injection in Treating Breast Cancer Patients with Myocardial Damage Caused by Sequential Chemotherapy of Trastuzumab and Anthracyclines

目的:探讨心脉隆注射液对蒽环类药物、曲妥珠单抗序贯治疗乳腺癌患者致心脏毒性的保护作用以及对血清白细胞介素(IL)-6和肿瘤坏死因子-α(TNF-α)含量的影响。方法:选择河北医科大学第四医院收治的乳腺癌患者60例,随机分为对照组和治疗组各30例;对照组应用曲妥珠单抗和蒽环类药物序贯治疗,吡柔比星60 mg·m-2;表阿霉素60 mg·m-2;曲妥珠单抗在蒽环类药物结束后开始下一疗程,首次剂量为8 mg·kg-1,此后6 mg·kg-1治疗;1周期/3周,共6周期,1次/周期。治疗组在对照组治疗基础上给予心脉隆注射液,于化疗前1 d开始给予,2支/次,7次/周期,化疗结束后继续治疗1周。比较两组中医临床症状评分,血清肌钙蛋白I(c Tn I)和心型游离脂肪酸结合蛋白(H-FABP)含量;检测两组治疗前后血液流变学变化,血清IL-6和TNF-α含量。结果:化疗结束时和化疗后1周,治疗组患者中医临床症状评分,血清c Tn I,H-FABP,全血高、中、低切黏度,血浆黏度,血清TNF-α,IL-6均显著低于对照组(P<0.01)。结论:心脉隆注射液针对蒽环类药物、曲妥珠单抗序贯治疗乳腺癌致心脏毒性,可明显改善患者临床症状和心肌损伤,降低血液黏度,抑制血清IL-6,TNF-α水平。

Objective： To discuss the protection effect of Xinmailong injection in treating breast cancer patients with myocardial damage caused by sequential chemotherapy of trastuzumab and anthracyclines and investigate its effect on serum levels of interleukin-6（ IL-6） and tumor necrosis factor（ TNF-α）. Method： Sixty breast cancer patients in our hospital were randomly divided into control group（ 30 cases） and treatment group（ 30cases） with reference to digital table method. Patients of control group were treated with sequential chemotherapy of trastuzumab（ after the periods of anthracyclines with first-dose of 8 mg ·kg- 1and 6 mg ·kg- 1hereafter） and anthracyclines（ pirarubicin,60 mg·m- 2and pharmorubicin,60 mg·m- 2）,1 course /3 weeks,1 time /course,6courses in total. Patients of treatment group were also given with Xinmailong injection based on the treatment of control group from one day before chemotherapy to one week after chemotherapy（ 2 injections / time,7times /course）. The symptomatic scores of traditional Chinese medicine（ TCM）,serum troponin I（ c Tn I） and heart-type fatty acid-binding protein（ H-FABP） in two groups were compared. Changes of hemorheology,serum IL-6 and TNF-α were detected before and after treatment in two groups. Result： The symptomatic scores of TCM,serum levels of c Tn I and H-FABP in treatment group were significantly lower than those in control group at the ending of chemotherapy and 1 week after chemotherapy（ P〈 0. 01）. Blood viscosities of high shearrate,middle shearrate and low shearrate,plasma viscosity,serum levels of IL-6 and TNF-α in treatment group were significantly lower than those in control group at the ending of chemotherapy and 1 week after chemotherapy,with statistically significant difference（ P〈 0. 01）. Conclusion： Xinmailong injection could effectively improve the clinical symptoms and myocardial damages in treating breast cancer patients with myocardial damage caused by sequential chemotherapy of trastuzumab and anthracyclines. The mechanism may be associated with decreasing blood viscosity and inhibiting expressions of serum IL-6 and TNF-α.