穴位贴敷对乳腺癌阿霉素化疗所致心脏毒性的影响

Effect of Acupoint Application on Cardiotoxicity Induced by Doxorubicin Chemotherapy for Breast Cancer

目的观察穴位贴敷对乳腺癌阿霉素化疗所致心脏毒性的影响。方法接受4周期阿霉素辅助化疗的64例早期浸润性乳腺癌患者,根据随机数字表分为穴位贴敷组和对照组,每组32例。穴位贴敷组在每周期化疗前30 min接受中药穴位贴敷治疗,其他治疗均与对照组相同。观察化疗前、化疗结束后两组患者Karnofsky功能状态评分(KPS)、证候评分、心脏毒副反应程度、心肌标志物水平[肌钙蛋白Ⅰ(cTnⅠ)和肌酸激酶同工酶(CK-MB)]、心电图情况及左室射血分数(LVEF)。结果两组化疗前KPS和证候评分比较,组间差异均无统计学意义(P>0.05);两组化疗后证候评分均较化疗前升高(P<0.05),穴位贴敷组化疗后证候评分明显低于对照组(P<0.05);对照组化疗后KPS明显低于化疗前(P<0.05),且明显低于穴位贴敷组化疗后(P<0.05)。穴位贴敷组心脏毒副反应较对照组减轻,差异有统计学意义(P<0.05)。两组化疗前心肌标志物水平(cTnⅠ和CK-MB)及LVEF差异均无统计学意义(P>0.05);两组化疗后cTnⅠ和CK-MB均较化疗前升高(P<0.05),LVEF均较化疗前降低(P<0.05);穴位贴敷组化疗后cTnⅠ和CK-MB低于对照组(P<0.05),而LVEF高于对照组(P<0.05)。穴位贴敷组化疗后心电图改变率低于对照组,差异有统计学意义(P<0.05)。结论穴位贴敷可降低乳腺癌阿霉素化疗所致心脏毒性并改善心脏功能。

Objective To observe the effect of acupoint application on cardiotoxicity induced by Doxorubicin chemotherapy for breast cancer.Method Sixty-four patients in early-stage invasive breast cancer who were going to receive 4 cycles of Doxorubicin-assisted chemotherapy were divided into an acupoint application group and a control group by the random number table,with 32 cases in each group.The acupoint application group received Chinese medicinal acupoint application 30 min before each chemotherapy cycle started,and the rest treatments were same as in the control group.The Karnofsky Performance Status(KPS)score,symptom and sign score,cardiotoxicity intensity,myocardial enzyme levels[Cardiac troponinⅠ(cTnⅠ)and creatine kinase isoenzyme MB(CK-MB)],electrocardiogram(ECG)and left ventricular ejection fraction(LVEF)were observed before and after chemotherapy in each group.Result There were no significant differences in the KPS and symptom and sign scores before chemotherapy between the two groups(P>0.05);the symptom and sign score increased after chemotherapy in both groups(P<0.05),but was significantly lower in the acupoint application group than in the control group(P<0.05);the KPS score decreased remarkably in the control group after chemotherapy(P<0.05),and was significantly lower than that in the acupoint application group(P<0.05).The acupoint application group showed milder cardiotoxic reactions compared with the control group,with statistical significance(P<0.05).There were no significant between-group differences in the levels of cTnⅠ,CK-MB and LVEF before chemotherapy(P>0.05);the levels of cTnⅠand CK-MB increased(P<0.05)and the LVEF decreased(P<0.05)after chemotherapy in both groups;after chemotherapy,the level of cTnⅠwas lower in the acupoint application group than in the control group(P<0.05),and the LVEF was higher(P<0.05).The ECG variation rate was lower in the acupoint application group than in the control group after chemotherapy,and the difference was statistically significant(P<0.05).Conclusion Acupoint application can reduce the cardiotoxicity caused by Doxorubicin chemotherapy for breast cancer and can improve cardiac function.