右丙亚胺对蒽环类药物引起乳腺癌术后患者心脏毒性的预防研究

Preventive Effects of Dexrazoxane on Anthracycline-Induced Cardiac Toxicity in Post-surgery Breast Cancer Patients

目的探讨右丙亚胺对于蒽环类化疗药物造成的乳腺癌患者心脏毒性的防治作用。方法选择乳腺癌术后接受蒽环类药物化疗的患者,采用随机数字表法分为观察组和对照组,各58例。观察组化疗前给予右丙亚胺静脉滴注。比较两组患者治疗6、12、24个月时的血清心肌钙蛋白T(cTnT)、B型脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)水平及左心室射血分数(LVEF);对比两组患者的化疗不良反应和心电图异常改变情况。结果治疗后,两组患者血清cTnT水平均明显高于治疗前(P<0.05);治疗6、12、24个月后,观察组患者血清cTnT水平均显著低于对照组(P<0.05)。治疗6个月后,对照组患者血清BNP水平显著升高,而观察组在治疗12个月后明显升高(P<0.05)。与治疗前相比,观察组患者治疗后血清CKMB水平无明显变化(P>0.05),对照组患者治疗24个月后明显升高(P<0.05),两组患者治疗后血清CK-MB水平无明显差异(P>0.05)。治疗24个月后,观察组患者LVEF水平显著低于治疗前(P<0.05),治疗12、24个月后,LVEF水平均明显高于对照组(P<0.05)。观察组患者心电图异常总发生率(19.0%)显著低于对照组(36.2%)(P<0.05)。两组患者化疗不良反应发生率无明显差异(P>0.05)。结论右丙亚胺可预防蒽环类化疗药物引起的乳腺癌术后心脏毒性,且未见其他明显不良反应。

Objective To investigate the preventive and therapeutic effects of dexrazoxane on cardiotoxicity of breast cancer patients induced by anthracycline drugs.Methods The selected post-surgery breast cancer patients receiving anthracycline chemotherapy were divided into observation group and control group by random number method.The patients in observation group were given intravenous drip of dexrazoxane before anthracycline treatment.The serum cardiac troponin T(cTnT),serum B-type natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB),and left ventricular ejection fraction(LVEF)after 6 months,12 months,and 24 months of treatment were compared between the two groups.Moreover,the adverse reactions of chemotherapy and abnormal changes of electrocardiogram were compared between the two groups.Results Compared with before treatment,the serum cTnT level of both groups increased after treatment,and the difference was statistically significant(P<0.05).After 6 months,12 months,and 24 months of treatment,the serum cTnT levels were significantly lower in observation group than in control group(P<0.05).Compared with before treatment,the serum BNP level increased in the control group after 6 months of treatment,but in the observation group,it increased after 12 months of treatment.There was a statistical difference between the two groups(P<0.05).Compared with before treatment,there was no significant difference in serum CK-MB in the observation group after treatment(P>0.05).The serum CK-MB level in the control group increased after 24 months of treatment(P<0.05).The LVEF level in the observation group decreased after 24 months of treatment as compared with before treatment(P<0.05).The levels of LVEF in the obser-vation group after 12 and 24 months of treatment were all significantly higher than those in the control group(P<0.05).The rate of abnormal ECG was lower in observation group(18.9%)than in control group(34.5%)(P<0.05).No significant differences were found in adverse reactions of chemotherapy between the two groups(P>0.05).Conclusion Dexrazoxane has protective effect on cardiac toxicity induced by anthracycline chemotherapeutics in post-surgery breast cancer patients,with tolerable adverse reaction.