蒽环类药物治疗乳腺癌心脏毒性的临床探讨

Clinical Study of Anthracyclines in the Treatment of Breast Cancer Cardiotoxicity

目的探讨蒽环类药物(ANT)治疗乳腺癌的心脏毒性,早期动态监测及干预,最大程度降低心脏毒性发生率,预防心力衰竭发生。方法选取该科自2014年1月—2019年9月接受正规化疗的60例乳腺癌患者为研究对象,检测患者ANT化疗前后血浆缺血修饰白蛋白(IMA)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、心电图(ECG)等心肌损伤指标的变化。结果治疗后IMA水平由(78.0±365.3)k U/L升高至(126.5±139.8)k U/L,差异有统计学意义(t=3.886,P<0.05);心肌酶及心电图改变差异无统计学意义(P>0.05)。当ANT累积剂量>500 mg/m^(2)时,IMA水平由(158.7±159.6)k U/L至(175.8±161.4)k U/L,差异有统计学意义(t=5.362, P<0.05),心肌酶改变差异无统计学意义(P>0.05)。当累积剂量>700 mg/m^(2)时,CKMB水平开始升高,由(18.1±202)U/L至(18.5±5.9)U/L,差异有统计学意义(t=2.369,P<0.05)。当累积剂量>500 mg/m^(2)时,心电图ST-T段改变15例(25%),窦性心动过速24例(40%),室性期前收缩6例(10%),房性期前收缩15例(25%),差异有统计学意义(χ^(2)=5.648,P <0.05)。结论ANT相关心脏毒性具有剂量累积性,IMA是预测ANT相关心脏毒性的敏感指标,与心肌酶及心电图结合可较早预测ANT相关心脏毒性。

Objective To investigate the cardiotoxicity of anthracyclines(ANT)in the treatment of breast cancer,early dynamic monitoring and intervention,to minimize the incidence of cardiotoxicity and prevent heart failure.Methods Sixty breast cancer patients who received regular chemotherapy in our department from January 2014 to September 2019 were selected as the research objects.Plasma ischemia modified albumin(IMA),creatine kinase(CK),creatine kinase(CK),and plasma ischemia modified albumin(IMA),creatine kinase(CK),and creatine kinase were detected before and after ANT chemotherapy.Changes in myocardial injury indicators such as creatine kinase isoenzyme(CKMB)and electrocardiogram(ECG).Results After treatment,the IMA level increased from(78.03±65.3)kU/L to(126.5±139.8)kU/L,the difference was statistically significant(t=3.886,P<0.05);there was no statistically significant difference in the changes of myocardial enzymes and electrocardiogram(P>0.05).When the cumulative dose of ANT>500 mg/m^(2),the IMA level from(158.7±159.6)kU/L to(175.8±161.4)kU/L,the difference was statistically significant(t=5.362,P<0.05),and there was no statistically significant difference in myocardial enzyme changes(P>0.05).When the cumulative dose>700 mg/m^(2),the CKMB level began to rise,from(18.1±20.2)U/L to(18.5±5.9)U/L,the difference was statistically significant at(t=2.369,P<0.05).When the cumulative dose was>500 mg/m^(2),the ST-T segment of ECG changes in 15 cases(25%),sinus tachycardia in 24 cases(40%),ventricular premature contraction in 6 cases(10%),atrial premature contraction 15 cases(25%),the difference was statistically significant(χ^(2)=5.648,P<0.05).Conclusion ANT-related cardiotoxicity is dose-cumulative.IMA is a sensitive indicator for predicting ANT-related cardiotoxicity.Combining with myocardial enzymes and electrocardiogram can predict ANT-related cardiotoxicity earlier.