FOLFOX4方案治疗中晚期肝细胞癌所致心脏毒性的研究

The study of cardiotoxicity of FOLFOX4 project on patients with advanced hepatocellular carcinoma

目的比较FOLFOX4方案与RALOX方案治疗中晚期肝细胞癌(hepatocellular carcinoma,HCC)所致的心脏毒性。方法选取7个医院就诊的中晚期HCC患者121例,其中采用FOLFOX4方案63例(观察组),采用RALOX方案58例(对照组)。比较两组患者心脏毒性的发生情况。结果两组心脏毒性均主要表现为Ⅰ级和Ⅱ级,但观察组Ⅰ级和Ⅱ级心脏毒性的发生率均高于对照组(19.0%vs 6.9%,P=0.049;14.3%vs 3.4%,P=0.038),心脏毒性总发生率亦高于对照组(36.5%vs 10.3%,P=0.001)。观察组心电图异常发生率明显高于对照组(36.5%vs 10.3%,P=0.001),但两组左室射血分数减低、心肌酶升高情况差异无统计学意义(P>0.05)。观察组心律失常、心肌缺血的发生率均高于对照组(31.7%vs10.3%,P=0.004;20.6%vs 6.9%,P=0.030)。结论 FOLFOX4方案治疗中晚期HCC所致的Ⅰ级和Ⅱ级心脏毒性高于RALOX方案,主要表现为心律失常及心肌供血不足。

Objective To compare the FOLFOX4 regimen and RALOX regimen in the treatment of cardiotoxicity induced by advanced hepatocellular carcinoma(HCC). Methods A total of 121 patients with advanced HCC were enrolled in 7 hospitals,including 63 patients with FOLFOX4 regimen(observation group) and 58 patients with RALOX regimen(control group). The incidence of cardiotoxicity was compared between the two groups. Results The cardiotoxicity of the observation group and the control group were mainly grade Ⅰ and grade Ⅱ,but the incidence of grade Ⅰ and grade Ⅱ cardiotoxicity in the observation group were significantly higher than those of the control group(19.0% vs 6.9%,P=0.049;14.3% vs 3.4%,P=0.038),and the total incidence of cardiotoxicity in the observation group was also higher than the control group(36.5% vs 10.3%,P=0.001). The incidence of abnormal electrocardiograph in the observation group was significantly higher than that in the control group(36.5% vs 10.3%,P=0.001).However,there were no significant difference in left ventricular ejection fraction and myocardial enzyme elevation between the two groups(P>0.05). The incidence of arrhythmia and myocardial ischemia in the observation group were both higher than those of the control group(31.7% vs 10.3%,P=0.004;20.6% vs 6.9%,P=0.030). Conclusions Grade Ⅰ and grade Ⅱ cardiotoxicity in the FOLFOX4 regimen caused by advanced HCC are higher than the RALOX regimen,and mainly characterized by arrhythmia and myocardial insufficiency.