流产增加三阴性乳腺癌患者化疗后远期不良心血管事件的发生

Abortion increases the incidence of long-term adverse cardiovascular events in patients with triple-negative breast cancer after chemotherapy

目的:探究流产与肿瘤和心血管之间的关系,从临床角度出发,能够为评估乳腺癌患者化疗后远期主要不良心血管事件提供新的研究方向。方法:以2016至2019年大冶市人民医院诊断为三阴性乳腺癌的患者为研究对象,收集上述患者临床资料,将所有患者分为流产组与非流产组,其中流产组分人工流产组与自然流产组两个亚组分析。对所有患者进行随访,分别比较两组乳腺癌患者3年内主要不良心血管事件发生率、全因死亡率、心血管病死亡率,用多变量Cox回归分析主要不良心血管事件的危险因素,用Kaplan-Meier生存曲线分析流产事件对三阴性乳腺癌死亡率及主要不良心血管事件发生率的影响。结果:研究结果显示,将流产组与非流产组的基线进行比较,两组的年龄、吸烟史比率、饮酒史比例、高血压比率、使用右丙亚胺比率、放疗比率差异无统计学意义(P>0.05);而基线中有无手术史、化疗的疗程组间差异有统计学意义(P<0.05)。所有乳腺癌患者两组3年内主要不良心血管事件发生率为5.5%,全因死亡率约为15.7%,而心血管原因死亡率占1.5%。将流产组与非流产组进行比较,其中流产组3年内主要不良心血管事件发生率较高(15.6%vs 3.4%,P<0.05),全因死亡率较高(29.4%vs 11.0%,P<0.05),且流产次数越多,发生3年内主要不良心血管事件发生率越高(P<0.05)。流产组和非流产组的心血管死亡比率差异无统计学意义(7.8%vs 0.7%,P>0.05)。患者3年主要不良心血管事件的多因素Cox回归分析显示:有无流产、年龄、手术、化疗疗程、是否放疗是全部患者3年主要不良心血管事件发生率的独立危险因素;而吸烟史、高血压史、有无使用右丙亚胺指标与患者3年主要不良心血管事件发生率之间无显著相关性(P>0.05)。在亚组分析中,人工流产组与自然流产组在3年主要不良心血管事件发生率、全因死亡率较高、心血管死亡比率差异无统计学意义(P>0.05)。通过Kaplan-Meier生存分析,流产组与非流产组相比,3年主要不良心血管事件发生率较高,差异有统计学意义(P<0.05)。结论:流产可增加三阴性乳腺癌患者化疗后远期不良心血管事件的发生。

Objective:To explore the relationship between abortion and cancer and cardiovascular diseases,and to provide a new research direction for the evaluation of long-term adverse cardiovascular events in breast cancer patients after chemotherapy.Methods:Clinical data of patients with triple negative breast cancer diagnosed in Daye People's Hospital from 2016 to 2019 were collected.All patients were divided into abortion group and non-abortion group,analysis of two subgroups of abortion group:artificial abortion group and natural abortion group.All patients were followed up and the incidence of major adverse cardiovascular events,all-cause mortality and cardiovascular mortality were compared between the two groups within 3 years,multivariate Cox regression was used to analyze risk factors for major adverse cardiovascular events,and Kaplan-Meier survival curves were used to analyze the effect of abortion on triple-negative breast cancer mortality and major adverse cardiovascular events.Re sults:The results of this study showed that when the baseline of the abortion group was compared with that of the non-abortion group,there was no significant difference in age,smoking history,drinking history,hypertension,use of dextranimide,radiotherapy between the two groups( P > 0.05).There were significant differences between groups with or without operation history and chemotherapy course at baseline( P < 0.05).Major adverse cardiovascular events occurred in 5.5%of all patients with breast cancer within 3 years in both groups,and all-cause mortality was approximately 15.7%,compared with 1.5% for cardiovascular causes.Comparing the abortion group with the non-abortion group,the abortion group had a higher rate of major adverse cardiovascular events at 3 years( 15.6% vs 3.4%,P < 0.05) and a higher rate of all-cause mortality( 29.4% vs 11.0%,P < 0.05).There was no significant difference in cardiovascular mortality between the abortion group and the non-abortion group( 7.8% vs 0.7%,P > 0.05).Cox regression analysis showed that abortion,age,operation,chemotherapy course and radiotherapy were independent risk factors of major adverse cardiovascular events in 3 years.There was no significant correlation between smoking history,hypertension history,use of dextromethamine and 3-year incidence of major adverse cardiovascular events( P > 0.05).In subgroup analysis,there was no statistically significant difference in the incidence of major adverse cardiovascular events,all-cause mortality rate,and cardiovascular mortality rate between the induced abortion group and the natural abortion group at 3 years.By Kaplan-Meier survival analysis,the 3-year rate of major adverse cardiovascular events was significantly higher in the abortion group than in the non-abortion group( P < 0.05).Conclusion:Abortion can increase the long-term adverse cardiovascular events in triple-negative breast cancer patients after chemotherapy.