景天丹芎汤预防乳腺癌患者发生蒽环类化疗药物所致心脏毒性的效果及可能机制

Effect and possible mechanism of Jingtian Danxiong Decoction for the prevention of cardiotoxicity induced by anthracycline chemotherapeutic drugs in patients with breast cancer

目的观察景天丹芎汤预防乳腺癌患者发生蒽环类化疗药物所致心脏毒性的效果,并初步探讨其可能作用机制。方法将120例乳腺癌患者随机分为对照组和观察组,每组60例。两组患者均于术后接受蒽环类化疗药物治疗,观察组患者同时口服景天丹芎汤。比较两组化疗期间的心血管事件发生情况,化疗4个周期后的心功能分级,以及化疗前后的心肌损伤相关血清学指标、血清氧化应激指标、血清内皮功能指标、左室射血分数(LVEF)、心率校正的QT(QTc)间期。结果(1)观察组化疗期间的心血管事件总发生率低于对照组,化疗4个周期后的心功能分级优于对照组(均P<0.05)。(2)与化疗前比较,两组化疗4个周期后的血清N末端B型利钠肽原、心肌肌钙蛋白I、肌红蛋白、丙二醛水平均升高,血清超氧化物歧化酶水平均降低;化疗2个周期后、4个周期后的LVEF均低于化疗前,QTc间期均较化疗前延长(均P<0.05)。化疗后观察组的上述指标均优于对照组(均P<0.05)。结论景天丹芎汤可以减轻蒽环类化疗药物对乳腺癌患者心脏的毒性作用,其作用机制可能与提高机体抗氧化能力、改善血管内皮功能有关。

Objective To observe the effect of Jingtian Danxiong Decoction for the prevention of cardiotoxicity induced by anthracycline chemotherapeutic drugs in patients with breast cancer,and to preliminarily explore the possible mechanism.Methods A total of 120 patients with breast cancer were randomly divided into control group or observation group,with 60 cases in each group.Patients of both groups received anthracycline chemotherapeutic drugs for treatment after operation,and the observation group simultaneously received oral administration of Jingtian Danxiong Decoction.The occurrence of cardiovascular events during chemotherapy,cardiac function classification after 4 cycles of chemotherapy,and pre-and post-chemotherapy myocardial injury-related serological indices,serum oxidative stress indices,serum endothelial function indices,left ventricular ejection fraction(LVEF),heart rate corrected QT(QTc)interval were compared between the two groups.Results(1)The observation group exhibited a lower total incidence rate of cardiovascular events during chemotherapy to compared with the control group,and a superior cardiac function classification after 4 cycles of chemotherapy to compared with the control group(all P<0.05).(2)Compared with before chemotherapy,the levels of serum N-terminal pro-brain natriuretic peptide,cardiac troponin I,myohemoglobin,and malondialdehyde were elevated in both groups,whereas serum superoxide dismutase level was decreased in both groups after 4 cycles of chemotherapy;furthermore,after 2 and 4 cycles of chemotherapy,the LVEF was lower as compared with before chemotherapy,while QTc interval was prolonged as compared with before chemotherapy(all P<0.05).The aforesaid indices of the observation group were superior to those of the control group after chemotherapy(all P<0.05).Conclusion Jingtian Danxiong Decoction can relieve anthracycline chemotherapeutic drugs on cardiac toxicity in patients with breast cancer,and its mechanism may be related to the body antioxidant capacity elevation,and vascular endothelial function improvement.