B型钠尿肽L-选择素E-选择素血浆水平在评估血液系恶性肿瘤蒽环类药物化疗对心肌毒性的临床意义初步研究  

Preliminary Study on the Clinical Significance of B-type Natriuretic Peptide L-selectin E-selectin Plasma Levels of the Blood System Malignant Tumor Patients in Evaluation the Anthracycline Cardiac Toxicity During Chemotherapy

作　　者：陈雪梅[1] 梁国华[1] 夏勇[1] 唐家明[1] 

机构地区：[1]广州医学院第三附属医院血液科,广东广州510150

出　　处：《河北医学》2010年第10期1153-1157,共5页Hebei Medicine

基　　金：广州市医药卫生科技立项资助项目(2008-YB-178)

摘　　要：目的:初步研究分析血液系恶性肿瘤患者B型钠尿肽、L-选择素、E-选择素血浆水平在评估蒽环类药物化疗对心肌毒性的临床意义。方法:检测22例应用蒽环类药物吡柔比星(THP)治疗的血液系恶性肿瘤患者化疗前后的血清钠尿肽(BNP)、L-选择素、E-选择素和磷酸肌酸激酶同工酶(CK-MB)水平,按照每平方米体表面积蒽环类药物吡柔比星累积剂量分为THP≤180mg组,180mg<THP≤360mg组,360mg<THP≤450mg,THP>450mg组,各组之间与治疗前以及正常对照组之间进行比较分析。结果:血液系恶性肿瘤患者22例治疗前平均血清BNP检测结果为62.36±12.59((pg/mL),L-选择素576.83±210.83(ng/mL),E-选择素40.75±30.34(ng/mL),CK-MB 12.45±5.60(u/L);THP≤180mg组22例,平均血清BNP检测结果为69.71±9.52((pg/mL),L-选择素994.08±400.22ng/mL),E-选择素52.25±27.69(ng/mL),CK-MB 13.62±5.80 u/L;180mg<THP≤360mg组18例,平均血清BNP检测结果为80.13±7.06((pg/mL),L-选择素1458.40±531.41(ng/mL),E-选择素95.14±47.61(ng/mL),CK-MB 13.28±6.65 u/L;360mg<THP≤450mg组15例,平均血清BNP检测结果为84.25±6.80((pg/mL),L-选择素1487.00±361.78(ng/mL),E-选择素111.20±61.66(ng/mL),CK-MB15.88±8.64(u/L);THP>450mg组10例,平均血清BNP检测结果为80.13±7.06((pg/mL),L-选择素1783.55±752.45(ng/mL),E-选择素95.83±36.68(ng/mL),CK-MB 32.45±30.17(u/L)。蒽环类药物吡柔比星每平方米体表面积累积剂量达到180mg-360mg后,血清BNP、L-选择素和E-选择素水平与治疗前相比有显著升高(P<0.01),而且随着蒽环类药物吡柔比星表面积累积剂量的增加有不断升高趋势,而CK-MB仅在蒽环类药物吡柔比星每平方米体表面积累积剂量>450mg时才较治疗前明显升高(P<0.01)。结论:B型钠尿肽、L-选择素、E-选择素在评价蒽环类药物吡柔比星(THP)治疗的血液系恶性肿瘤患者早期心脏功能损害方面较CK-MB敏感,血清B型钠尿肽是敏感的指标,血清L-选择素和E-选择素可能与B型钠�Objective： The preliminary study on the clinical significance of B-type natriuretic peptide,L-selectin,E-selectin plasma levels of the blood system malignant tumor patients in evaluation the anthracycline cardiac toxicity during chemotherapy.Method： We detected B-type natriuretic peptide（BNP）、L-selectin、E-selectin and creatine kinase（CK-MB）plasma levels of 22 cases treated with anthracycline pirarubicin（THP） of the blood cancer before and after chemotherapy.The cases were assigned to THP ≤ 180mg group,180mg 〈THP ≤ 360mg group,360mg 〈THP≤450mg group,THP〉 450mg group according to the anthracycline pirarubicin cumulative doses of THP of per square meter of body surface area.Comparative analysis of BNP、L-selectin、E-selectin and CK-MB plasma levels between the control group and before treatment group and normal group.Result： After anthracycline pirarubicin cumulative dose reach to 180mg-360mg per square meter of body surface area,The level of BNP,L-selectin and E-selectin in all control groups increased significantly compared with those the before treatment group（P 〈0.01）,and there was a Continuously rising trend with the increasing of anthracycline pirarubicin accumulative dose.While the level of MB increased significantly only when the anthracycline pirarubicin accumulative dose per square meter of body surface area exceed 450mg compared with those in before treatment group（P 〈0.01）.Conclusion： This study shows the plasma level of BNP,L-selectin and E-selectin were more sensitive than CK-MB in evaluation the anthracycline cardiac toxicity during chemotherapy of blood cancer,BNP is a sensitive index in evaluation the anthracycline cardiac toxicity,L-selectin and E-selectin maybe also is a sensitive index the same as BNP,which need to be further studied.

关 键 词：蒽环类药物 B型钠尿肽 L-选择素 E-选择素 

分 类 号：R733[医药卫生—肿瘤]