乳腺癌术后蒽环类化疗药物致心脏损害的早期监测分析

Analysis of Early Monitoring for Heart Damage Caused by Anthracyclines Chemotherapy Drugs after Breast Cancer Surgery

目的:考察乳腺癌术后蒽环类化疗药物致心脏损害患者的心电图(ECG)、血清心肌肌钙蛋白Ⅰ(cTnⅠ)、血清乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)和肌酸激酶同功酶(CKMB)的早期变化情况,探讨其在心脏损害早期诊断中的意义。方法:回顾性分析我院2015年1月-2016年6月乳腺癌术后以蒽环类药物为主进行化疗的152例病例资料,根据药物性心脏毒性诊断标准,评价其住院及1年随访过程中是否发生心脏损害,根据评价结果分为损害组50例和对照组102例。在患者接受蒽环类药物化疗前(T0)、第1个周期结束后24 h(T_1)、第2个周期结束后24 h(T_2)及第4个周期结束后24 h(T_3)分别检测ECG、cTnⅠ、LDH、CKMB、α-HBDH水平。结果:T_1、T_2、T_3时,损害组患者ECG异常比例显著高于对照组,cTnⅠ、LDH、CKMB、α-HBDH均显著高于对照组,差异均有统计学意义(P<0.01)。结论:早期联合监测ECG、cTnⅠ和心肌酶LDH、CKMB、α-HBDH,能够提高乳腺癌术后蒽环类化疗药物致心脏损害的早期诊断效率,改善患者的预后。

OBJECTIVE:To investigate the early changes of ECG,cTnⅠ,LDH,α-HBDH and CKMB in patients with anthracyclineschemotherapy-induced heart damage after breast cancer surgery,and to explore their significances in the diagnosis of earlyheart damage.METHODS:Medical information of152cases of anthracyclines chemotherapy after breast cancer surgery in our hospital during Jan.2015-Jun.2016were analyzed retrospectively.According to diagnosis criteria of drug-induced cardiotoxicity,theoccurrence of heart damage was evaluated during hospitalization and1-year follow-up.According to evaluation results,those patientswere divided into heart damage group(50cases)and control group(102cases).The early changes of ECG,cTnⅠ,LDH,CKMB andα-HBDH were analyzed before chemotherapy(T0),24h after first chemotherapy(T1),24h after second chemotherapy(T2),24h after forth chemotherapy.RESULTS:At T1,T2,T3,the proprotion of ECG abnormalities in heart damage group wassignificantly higher than control group;the serum levels of cTnⅠ,LDH,CKMB andα-HBDH in heart damage group were significantlyhigher than control group,with statistical significance(P<0.01).CONCLUSIONS:For anthracyclines chemotherapydrugs-induced heart damage after breast cancer surgery,early regular monitoring of ECG,cTnⅠ,LDH,CKMB andα-HBDH canimprove the efficiency of early diagnosis of heart damage,and improve prognosis.