沙库巴曲缬沙坦改善乳腺癌患者曲妥珠单抗所致心力衰竭的效果研究

Effect of Sakubastral/valsartan on the Improvement of Heart Failure Induced by Trastuzumab in Breast Cancer Patients

背景曲妥珠单抗是临床治疗乳腺癌的靶向药物,但其可能诱发心力衰竭,延误患者治疗并影响药物的使用。而沙库巴曲缬沙坦是治疗心力衰竭的一线用药,但其能否改善化疗药物所致心力衰竭尚不得知。目的评估沙库巴曲缬沙坦对乳腺癌患者曲妥珠单抗所致心力衰竭的疗效,以期为临床工作提供更多的参考依据。方法选取2019年1—10月于湖北医药学院附属太和医院心血管内科住院的曲妥珠单抗所致心力衰竭的乳腺癌患者62例为研究对象。根据住院号单双号将患者分为常规治疗组(单号,n=28)及沙库巴曲缬沙坦组(双号,n=34)。常规治疗组仅接受基本药物治疗,沙库巴曲缬沙坦组在常规治疗组的基础上使用沙库巴曲缬沙坦替换肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂,两组均治疗2个月。比较两组临床疗效和治疗前、治疗后6 min步行距离(6MWD)、N末端脑钠肽前体(NT-proBNP)、心电图指标(包括平均心率、P-R间期、QRS宽度、室上性期前收缩个数、室性期前收缩次数)、心脏彩色多普勒超声检查指标〔包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕,记录两组药物不良反应发生情况。结果沙库巴曲缬沙坦组治疗总有效率高于常规治疗组(P<0.05)。治疗后,沙库巴曲缬沙坦组6MWD大于常规治疗组,NT-proBNP低于常规治疗组(P<0.05)。治疗后,沙库巴曲缬沙坦组LVEF高于常规治疗组(P<0.05);治疗后,两组LVEDD、LVESD比较,差异无统计学意义(P>0.05)。常规治疗组、沙库巴曲缬沙坦组均未发生严重胃肠道反应、心悸、皮疹等药物不良反应。结论沙库巴曲缬沙坦能够改善乳腺癌患者曲妥珠单抗所致心力衰竭症状,提高患者心功能,减少心律失常的发生,有助于患者的临床康复。

Background Trastuzumab is a targeted drug for the clinical treatment of breast cancer,but it may induce heart failure(HF),delay the treatment of patients and affect the use of drugs.Sakubastral/valsartan is the first-line drug in the treatment of HF,but whether it can improve the HF caused by chemotherapy drugs is not known.Objective To investigate the effect of sakubastral/valsartan on the improvement of HF induced by trastuzumab in breast cancer patients,in order to provide more reference for clinical work.Methods From January to October 2019,62 breast cancer patients with HF caused by trastuzumab in the Department of Cardiology Medicine,Affiliated Taihe Hospital of Hubei University of Medicine were selected as the study objects.According to the inpatient number,the patients were divided into two groups:the conventional treatment group(single number,n=28)and the sakubatral/valsartan group(double number,n=34).The conventional treatment group received only basic medical treatment,and the sakubastral/valsartan group used the sakubastral/valsartan to replace the reninangiotensin-aldosterone system(RAAS)blocker based on the conventional treatment group.Both groups were treated for 2 months.The treatment efficacy and 6-minute walk distance(6MWD),NT-proBNP,electrocardiographic indicators(including average heart rate,P-R interval,QRS width,number of supraventricular premature beats,number of ventricular premature beats),and cardiac color Doppler ultrasound examination indicators〔including left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)〕before and after treatment were compared between the two groups.Adverse reactions were recorded in both groups.Results The total effective rate of the sakubatral/valsartan group was higher than that of the conventional treatment group(P<0.05).After treatment,the 6MWD in the sakubatral/valsartan group was larger than that in the conventional treatment group,and NT-proBNP was lower than that in the conventional treatment group(P<0.05).After treatment,the LVEF of the sakubatral/valsartan group was higher than that of the conventional treatment group(P<0.05);after treatment,there was no statistically significant difference in LVEDD and LVESD between the two groups(P>0.05).There were no serious gastrointestinal reactions,palpitations,rashes and other adverse reactions in the routine treatment group and the sakubatral/valsartan group.Conclusion Sakubastral/valsartan can improve symptoms of HF caused by trastuzumab in breast cancer patients,improve the heart function of patients,reduce the occurrence of arrhythmia,which is helpful for the clinical rehabilitation of patients.