右丙亚胺对表阿霉素辅助化疗时的心脏保护作用及其机制分析

Analysis of cardioprotective role of adjuvant chemotherapy and its mechanism of dexrazoxane(DEX) on epirubicin(EPI)

目的:探讨右丙亚胺(DEX)对表阿霉素(EPI)辅助化疗时的心脏保护作用及其机制。方法:将69例采用EPI辅助化疗方案的女性乳腺癌患者随机分为对照组(n=34)与观察组(n=35),观察组患者在EPI辅助化疗的基础上加用DEX,对照组患者未加用DEX。比较两组患者化疗前后B型脑利钠肽(BNP)、心肌肌钙蛋白(c Tn T)、左心室射血分数(LVEF)、心率(HR)、收缩压(SBP)、舒张压(DBP)、ANC计数及非心脏毒性反应、SF-12生活量表评分。结果:观察组除ANC水平外,其他心脏及血液学功能指标(BNP、c Tn T、LVEF、HR、SBP、DBP)水平差异均无统计学意义(P>0.05);对照组患者化疗后BNP、c Tn T及HR水平均显著高于化疗前(P<0.05),化疗后LVEF水平显著低于化疗前(P<0.05)。对照组非心脏毒性反应发生率为58.82%,观察组为54.28%,差异无统计学意义(P>0.05)。根据SF-12生活量表评分,观察组患者化疗后各维度评分均显著高于对照组(P<0.05)。自化疗5个周期开始,治疗后半年和1年,对照组心电图异常明显多于观察组(P<0.05)。结论:DEX对行EPI辅助化疗的乳腺癌患者心脏具有较好地保护作用,且可有效改善患者生活质量。

Objective：To investigate the eardioproteetive role of adjuvant chemotherapy and its mechanism of dexrazoxane（DEX） on epirubicin（EPI）. Methods： 69 cases of the use of adjuvant chemotherapy for EPI female breast cancer patients were randomly divided into control group（ n = 34） and observation group（ n = 35 ） ,the observa- tion group were based on EPI on the use of adjuvant chemotherapy DEX,control patients didn1 use DEX. They were compared B - type brain natriuretic peptide （ BNP ） , cardiac troponin （ eTnT ） , left ventrieular ejection fraction （ LVEF）, heart rate （ HR）, systolic blood pressure （ SBP）, diastolic blood pressure （ DBP）, ANC count before and after chemotherapy and non- cardiac toxicity ,SF- 12 scale score of life were compared. Results：In addition to the ANC study group level, other cardiac and hematological function index（ BNP, cTnT, LVEF, HR, SBP, DBP） levels were not significantly different（ P 〉 0.05 ）. Control group after chemotherapy in patients with BNP,cTnT and HR were signifi- cantly higher than that before chemotherapy （ P 〈 0.05 ）. After chemotherapy LVEF was significantly lower than that before chemotherapy（P 〈0.05）. A control group of non- cardiac toxicity rate was 58.82% ,the observation group 54.28% ,the difference was not statistically significant（ P 〉 0.05 ）. Life according to SF -12 scale score was observed after chemotherapy patients all dimension scores were significantly higher（ P 〈 0.05 ）. After 5 cycles of chemotherapy, half a year and one year after treatment, the abnormal ECG in the control group were significantly higher than those in the observation group （ P 〈 0.05 ）. Conclusion ： DEX cardiac breast cancer adjuvant chemotherapy for patients with EPI have better protection, and can effectively improve the quality of life of patients.