卡维地洛联合曲美他嗪对接受含蒽环类药物化疗乳腺癌患者的心脏保护作用  

Heart Protective Effect of Carvedilol Combined With Trimetazidine on Breast Cancer Patients Receiving Anthracycline-containing Chemotherapy

作　　者：张守文[1] 张小霞[2] 石增成[1] 李峥嵘[3] 张金岭[4] 李洪升[5] 

机构地区：[1]山东大学附属临沂市人民医院心内科,山东省临沂市276000 [2]山东大学附属临沂市人民医院乳腺与甲状腺科,山东省临沂市276000 [3]山东大学附属临沂市人民医院药学部,山东省临沂市276000 [4]山东大学附属临沂市人民医院肿瘤科,山东省临沂市276000 [5]山东省肿瘤医院放疗六病区

出　　处：《中国全科医学》2016年第7期794-798,共5页Chinese General Practice

基　　金：山东省医药卫生科技发展计划项目(2013WS0082)

摘　　要：目的探讨卡维地洛联合曲美他嗪对接受含蒽环类药物化疗乳腺癌患者的心脏保护作用。方法选取2011-03-07至2013-06-30山东大学附属临沂市人民医院乳腺与甲状腺科收治的乳腺癌根治术后含蒽环类药物化疗患者114例。采用随机数字表法,将其分为对照组56例和研究组58例。分别于化疗前和化疗3、6个周期后,对两组进行心电图检查、心脏彩超检查、肌钙蛋白T(CTn T)水平检测,并记录化疗过程中的非血液系统不良反应/事件发生情况。结果两组年龄和病理分期分布情况比较,差异无统计学意义(P>0.05)。化疗3个周期后,两组心电图检查ST-T异常发生率比较,差异有统计学意义(P<0.05);而QRS波群电压下降、心律失常发生率比较,差异无统计学意义(P>0.05)。化疗6个周期后,两组ST-T异常、QRS波群电压下降、心律失常发生率比较,差异均有统计学意义(P<0.05)。化疗过程中,两组左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室舒张早期快速充盈峰与左心房主动收缩充盈峰比值(E/A)比较,差异有统计学意义(P<0.05);不同时间比较,差异有统计学意义(P<0.05);两者间存在交互作用,差异有统计学意义(P<0.05)。化疗3个周期后,两组CTn T异常发生率比较,差异无统计学意义(P>0.05);化疗6个周期后,两组CTn T异常发生率比较,差异有统计学意义(P<0.05)。化疗期间,患者均发生了脱发现象;两组头晕/头痛、乏力、血压升高、恶心/呕吐、腹胀及腹泻发生率比较,差异无统计学意义(P>0.05);血压下降、心率增快及心率减慢发生率比较,差异有统计学意义(P<0.05)。结论卡维地洛联合曲美他嗪可以降低含蒽环类药物化疗对乳腺癌患者的心脏毒性,且耐受性和安全性较好。Objective To investigate the heart protective effect of carvedilol combined with trimetazidine on breast cancer patients who received anthracycline- containing chemotherapy. Methods We enrolled 114 breast cancer patients who received anthracycline- containing chemotherapy following radical mastectomy who were admitted into the breast and the thyroid department of Linyi People＇ s Hospital Affiliated to Shandong University from March 7,2011 to June 30,2013. Using random number table method,we divided the patients into two groups： control group（ n = 56） and research group（ n = 58）. Before chemotherapy and after 3- cycle and 6- cycle chemotherapy,we conducted electrocardiography,heart color Doppler ultrasound examination and detection of CTn T level, and recorded adverse reactions / events of non- hematologic systems during chemotherapy. Results The two groups were not significantly different in age and pathological staging distribution（ P〉0. 05）.After 3- cycle chemotherapy,the two groups were significantly different in the incidence of ST- T abnormality（ P〈0. 05）,but the two groups were not significantly different in the incidence rates of QRS voltage reduction and arrhythmi（ P〉0. 05）. After6- cycle chemotherapy,the two groups were significantly different in ST- T abnormality,QRS voltage reduction and arrhythmia（P〈0. 05）. During chemotherapy,the two groups were significantly different in LVEF,LVEDD and E/A（ P〈0. 05）;significant differences existed among different time points（ P〈0. 05）; interaction effect existed between the two variables of group and time point（ P〈0. 05）. After 3- cycle chemotherapy,the two groups were not significantly different in the incidence of CTn T abnormality（ P〈0. 05）; after 6- cycle chemotherapy,the two groups were significantly different in the incidence rate of CTn T abnormality（ P〈0. 05）. During chemotherapy, alopecia occurred in all patients, and the two groups were not significantly different in the incidence rates of d

关 键 词：乳腺肿瘤 放化疗 辅助 蒽环类 卡维地洛 曲美他嗪 心脏保护 

分 类 号：R737.9[医药卫生—肿瘤]