恶性肿瘤患者应用紫杉醇化疗过程中合并心肌损伤的影响因素分析

Analysis of influencing factors for concurrent myocardiac injury in patients with malignant tumor during paclitaxel chemotherapy

目的 分析恶性肿瘤患者应用紫杉醇化疗过程中合并心肌损伤的影响因素。方法选取2017年9月至2022年9月期间在简阳市人民医院使用紫杉醇进行化疗的恶性肿瘤患者,共110例。回顾性分析患者的临床资料,将出现心肌损伤的患者作为观察组(35例),未出现心肌损伤患者作为对照组(75例),比较两组患者的临床资料。将单因素分析中存在差异的多个因素纳入多因素Logistic回归模型分析恶性肿瘤患者应用紫杉醇化疗过程合并心肌损伤的影响因素。结果 110例使用紫杉醇进行化疗的恶性肿瘤患者中,有35例(31.82%)发生心肌损伤,有75例(68.18%)未发生心肌损伤。单因素分析结果显示,两组患者年龄、高血压史、性别、糖尿病史、肥胖、脑钠肽(BNP)、心肌肌钙蛋白I(cTnI)、C反应蛋白(CRP)、紫杉醇单次使用剂量、紫杉醇累积使用剂量、治疗周期、给药方案比较差异有统计学意义(t/χ^(2)=5.682、4.716、5.858、6.074、10.174、120.005、46.687、10.430、5.002、4.604、5.170、5.303,均P <0.05)。多因素Logistic回归分析结果显示,年龄≥65岁、BNP、cTnI、CRP、紫杉醇单次使用剂量、紫杉醇累积使用剂量、治疗周期、给药方案均是恶性肿瘤患者应用紫杉醇发生心肌损伤的影响因素[OR(95%CI)=3.080(1.747~4.413)、1.984(1.488~2.480)、1.856(1.244~2.467)、1.728(1.467~1.989)、1.853(1.132~2.575)、9.393(8.509~10.277)、4.618(3.844~5.392)、4.272(3.190~5.354),均P <0.05]。结论 年龄≥65岁、BNP、cTnI、CRP、紫杉醇单次使用剂量、紫杉醇累积使用剂量、治疗周期、给药方案均是恶性肿瘤患者应用紫杉醇化疗过程中发生心肌损伤的影响因素,临床医师在应用紫杉醇治疗时应重视上述因素,以减少发生心肌损伤的风险。

Objective To analyze the influencing factors for concurrent myocardial injury in malignant tumor patients during paclitaxel chemotherapy.Methods A total of 110 malignant tumor patients who received paclitaxel chemotherapy at Jianyang People's Hospital from September 2017 to September 2022 were selected.Clinical data of the patients were retrospectively analyzed.Patients were divided into two groups:35 patients with myocardial injury in the observation group and 75 patients without myocardial injury in the control group.Clinical data between the two groups were compared.Factors with differences in univariate analysis were included in a multivariate Logistic regression model to analyze the influencing factors for concurrent myocardial injury in patients with malignant tumors during paclitaxel chemotherapy.Results Among 110 malignant tumor patients receiving paclitaxel chemotherapy,35 cases(31.82%)experienced myocardial injury,while 75 cases(68.18%)did not.Univariate analysis showed that there were statistically significant differences in age,history of hypertension,gender,history of diabetes,obesity,B-type natriuretic peptide(BNP),cardiac troponin I(cTnI),C-reactive protein(CRP),single dose of paclitaxel,cumulative dose of paclitaxel,treatment cycle,and dosage regimen between the two groups(t/χ^(2)=5.682,4.716,5.858,6.074,10.174,120.005,46.687,10.430,5.002,4.604,5.170,5.303;P<0.05).Multivariate Logistic regression analysis showed that age≥65 years old,BNP,cTnI,CRP,single dose of paclitaxel,cumulative dose of paclitaxel,treatment cycle and dosage regimen were influencing factors for myocardiac injury in malignant tumor patients receiving paclitaxel[OR(95%CI)=3.080(1.747-4.413),1.984(1.488-2.480),1.856(1.244-2.467),1.728(1.467-1.989),1.853(1.132-2.575),9.393(8.509-10.277),4.618(3.844-5.392),4.272(3.190-5.354);P<0.05].Conclusion Age≥65 years old,BNP,cTnI,CRP,single dose of paclitaxel,cumulative dose of paclitaxel,treatment cycle and dosage regimen are influencing factors for myocardiac injury in patients with malignant tumors during paclitaxel chemotherapy.Clinicians should pay attention to these factors when using paclitaxel therapy to reduce the risk of myocardial injury.