磷酸肌酸钠防护化学治疗所致心肌损伤的超声心动图评价

Ultrasonic Cardiogram Evaluation of Creatine Phosphate Sodium on Preventing Chemotherapy- Induced Myocardial Injury

目的采用超声心动图评价磷酸肌酸钠对化学治疗(简称化疗)所致心肌损伤的保护作用。方法选择2011年1月至2015年7月收治的行乳腺癌根治术后继续化疗的患者98例,随机分为对照组和治疗组,各49例。两组患者根据个人情况按不同方案常规化疗。对照组静脉滴注维生素C,于化疗当天开始,每日1次,连续7 d;观察组静脉滴注磷酸肌酸钠,每日2次,连续7 d,两组患者治疗疗程均与化疗疗程同步。观察两组患者治疗后心电图异常发生率,治疗前后超声心动图评价指标及治疗前后心肌损害相关生化指标,记录不良反应的发生情况。结果治疗后,两组患者Q-T间期离散度(Q-Tcd)均较治疗前增大,但观察组增大程度不及对照组,差异均有统计学意义(P<0.05);两组患者治疗后均出现ST-T段改变、QRS波压低及QT间期延长,而观察组上述心电图改变的发生率均不及对照组高,差异有统计学意义(P<0.05)。治疗后,对照组及观察组患者超声心动图检测左室射血分数(LVEF)、左心心肌作功指数(Tei)、左心室舒张末期前后径(LVEDd)、二尖瓣舒张早期流速峰值/二尖瓣舒张晚期流速峰值(E/A)均较治疗前发生变化,且观察组患者治疗后的上述指标波动幅度小于对照组治疗后,差异有统计学意义(P<0.05)。治疗后,两组患者肌酸激酶同工酶杂化型(CK-MB)、心肌肌钙蛋白(c Tn I)、B型钠尿肽(BNP)指标均增高,但观察组患者增高程度不及对照组,差异有统计学意义(P<0.05)。两组患者总不良反应发生率相当,差异无统计学意义(P>0.05)。结论超声心电图是检测化疗对心肌损害的有效手段;磷酸肌酸钠治疗化疗致心肌损害具有一定疗效,可显著降低患者心功能异常各项指标,且并未增加不良反应发生率,适合临床推广。

Objective To evaluate the protective effect of creatine phosphate sodium on chemotherapy- induced myocardial injury by ultrasonic cardiogram. Methods 98 breast cancer patients after radical continue chemotherapy from January 2011 to July 2015 were randomly divided into control and treatment groups,49 cases in each group. The two groups received different conventional chemotherapy program on an individual basis. The control group received intravenous vitamin C at the beginning of the chemotherapy, once daily, for continuous 7 d; the observation group received intravenous creatine phosphate sodium, 2 times a day for 7 d. The two groups were syn- chronized with the course of chemotherapy treatment. The incidence of abnormal electrocardiogram after treatment, and the ultrasonic car- diogram before and after treatment were observed; the myocardial damage related biochemical indicators were evaluated before and after treatment; the occurrence of adverse reactions were recorded. Results After treatment, the levels of Q-Ted of the patients were in- creased than before treatment, but the observation group increased to a lesser extent than the control group, the differences were statisti- cally significant（P 〈 0.05）; the ST-T segment change, QRS wave depression and QT prolongation incurred in both groups after the treatment, and the incidence rate of ECG change in the observation group were not as high as the control group（ P 〈 0. 05）. After treatment, the LVEF, left ventrieular Tei, LVED, E/A by ultrasonic cardiogram all changed in the two groups, and the fluctuations of these changes in the observation group were smaller than the control group after treatment, the differences were statistically significant （P 〈 0.05）. The levels of Pro- BNP, CK- MB, cTnI indicators were increased in the two groups, but the observation group increased to a lesser extent than the control group, the differences were statistically significant（ P 〈 0.05）. The overall incidence rates of adverse reactions in the two groups were equal, and the difference was not statistically significant（ P 〉 0. 05）. Conclusion Ultrasonic cardiogram is an effective means of detecting myocardial damage induced by chemotherapy. Creatine sodium phosphate has a certain effect on chemotherapy- induced myocardial damage, can significantly reduce cardiac dysfunction indicators without increasing the incidence rate of adverse reactions, which is suitable for clinical promotion.