对卡培他滨在44例胃癌化疗患者导致心肌损害的观察

Capecitabine causes myocardial damage in gastric cancer chemotherapy and its early prediction

目的评估血清心肌肌钙蛋白I(cTnI)和B型脑钠肽(BNP)对加用卡培他滨化疗的胃癌患者致心肌损害的早期预测。方法选取2017年7月至2018年6月辽宁省肿瘤医院接受治疗的晚期胃癌患者88例作为研究对象进行回顾性分析,按照治疗方法不同分为紫杉醇+顺铂(PC)双药联合组和紫杉醇+顺铂+卡培他滨(PCX)三药联合组。分别在治疗前、疗程结束后、疗程结束后3个月以cTnI和BNP为指标进行分析,同时分析患者治疗前和治疗后心电图变化规律。结果疗程结束PCX三药联合组与PC双药联合组血清cTnI浓度分别为(0.5829±0.0124)μg/L、(0.0598±0.0112)μg/L,两组比较差异有统计学意义(P<0.05);疗程结束后3个月随诊,两组血清cTnI浓度分别为(0.5585±0.0156)μg/L、(0.0518±0.0099)μg/L,两组比较差异有统计学意义(P<0.05);疗程结束PCX三药联合组与PC双药联合组血清BNP浓度分别为(495.6±35.6)ng/L、(154.3±29.8)ng/L,两组比较差异有统计学意义(P<0.05),疗程结束后3个月随诊,两组血清BNP浓度比较差异无统计学意义(P>0.05)。两组治疗前心电图平均异常率为21.6%(平均9.5例),治疗后心电图平均异常率为28.4%(平均12.5例),差异无统计学意义(P>0.05)。结论对接受加用卡培他滨三药联合方案化疗的胃癌患者可导致心肌损害,早期检测cTnI和BNP水平可早期预测心肌损害,及时调整方案可使卡培他滨的临床应用更安全有效。

Objective To evaluate the effect of serum cardiac troponin I(cTnI)and B-type brain natriuretic peptide(BNP)on early prediction of myocardial damage in gastric cancer patients treated with capecitabine chemotherapy.Methods From July 2017 to June 2018,88 patients with advanced gastric cancer who received treatment in Liaoning Cancer Hospital&Cancer Hospital of China Medical University were selected for retrospective analysis.According to different treatment methods,they were divided into paclitaxel combined with cisplatin(PC)treatment group and PC combined with capecitabine(PCX)treatment group.Serum cTnI and BNP were used as indexes before treatment,after treatment and three months after treatment.At the same time,the changes of ECG before and after treatment were analyzed.Results At the end of the course of treatment,the serum cTnI concentration of PCX treatment group and PC treatment group was(0.5829±0.0124)μg/L and(0.0598±0.0112)μg/L,respectively,with statistical significance(P<0.05);three months after the course of treatment,the serum cTnI concentration of the two groups was(0.5585±0.0156)μg/L and(0.0518±0.0099)μg/L respectively,with statistical significance(P<0.05).And at the end of the course,the serum BNP concentration of PCX treatment group and PC treatment group was(495.6±35.6)ng/L and(154.3±29.8)ng/L respectively,with statistical difference between the two groups(P<0.05).Three months after chemotherapy,the serum BNP concentration of the two groups was(155.5±29.6)ng/L and(139.6±30.1)ng/L,with no statistical difference(P>0.05).There was no significant difference of BNP concentration between the two groups after treatment for 3 months(P>0.05).The average abnormal rate of ECG before treatment was 21.6%(9.5 cases on average)and after treatment was 28.4%(12.5 cases on average),there was no significant difference between the two groups(P>0.05).Conclusions Early detection of cTnI and BNP concentrations can predict early myocardial damage in gastric cancer patients receiving capecitabine chemotherapy,and timely adjustment of the regimen can make the clinical application of capecitabine safer and more effective.