蒽环类药物治疗乳腺癌的心血管风险及对策  

Cardiovascular risk of anthracyclines in treatment of breast cancer and its strategy

作　　者：张萌萌[1] 洛菲[2] Zhang Mengmeng, Luo Fei(1.Graduate School, Shanxi Medical University, Taiyuan 030001, China; 2.Department of ICU, Shanxi Provincial Cancer Hospital, Taiyuan 030013, China)

机构地区：[1]山西医科大学研究生院,太原030001 [2]山西省肿瘤医院ICU,太原030013

出　　处：《肿瘤研究与临床》2018年第3期173-175,179,共4页Cancer Research and Clinic

摘　　要：目的评估接受蒽环类药物化疗乳腺癌患者的心脏不良反应。方法收集山西省肿瘤医院2014年1月至2016年12月接受吡柔比星（40 mg/m2）＋多西紫杉醇（75 mg/m2）方案化疗的乳腺癌患者291例，比较化疗前后患者心电图、超声心动图及心肌酶检测水平的变化。结果使用蒽环类药物化疗的乳腺癌患者化疗前心电图出现ST-T段改变14例（4.8%），房性期前收缩6例（2.1%），室性期前收缩8例（2.7%），化疗后心电图发生上述异常者分别为62例（21.4%）、47例（16.2%）及52例（17.9%），化疗前后心电图异常发生率比较，差异有统计学意义（χ2=6.249，P〈0.05）。化疗后左心室平均射血分数为0.72±0.10，低于化疗前的0.81±0.18，差异有统计学意义（t=3.480，P〈0.05）。化疗后肌酸激酶（CK）、天冬氨酸氨基转移酶（AST）、肌酸激酶同工酶（CK-MB）表达水平分别为（68±20）、（35±13）、（15.1±4.0）U/L，均高于化疗前的（50±12）、（28±12）、（7.9±2.6）U/L，差异均有统计学意义（t值分别为9.721、5.137、18.850，均P〈0.005）。结论蒽环类药物的使用可增加乳腺癌患者发生心电图异常及心肌损伤的风险，化疗过程中应注意心脏动态监测。ObjectiveTo evaluate the clinical cardiovascular reverse reactions of the patients with breast cancer who received chemotherapy with anthracyclines.MethodsTwo hundred and ninety-one cases of breast cancer who were treated with pirarubicin （40 mg/m2） ＋ docetaxel （75 mg/m2） in Shanxi Provincial Cancer Hospital from January 2014 to December 2016 were collected. The changes of electrocardiogram （ECG）, echocardiography and myocardial enzyme were recorded before and after chemotherapy.ResultsBefore chemotherapy, there were 14 patients （4.8%） with ST-T segment changes before ECG, 6 patients （2.1%） with atrial extrasystole, 8 patients （2.7%） with ventricular extrasystole. After chemotherapy, cases with abnormal ECG were 62 （21.4%）, 47 （16.2%） and 52 （17.9%） respectively. The difference between the two groups was statistically significant （χ 2 = 6.249, P 〈 0.005）. The average left ventricular ejection fraction after chemotherapy was significantly lower than that before chemotherapy （0.72±0.10 vs. 0.81±0.18, t = 3.480, P 〈 0.05）. The levels of creatine kinase （CK）, aspartate aminotransferase （AST） and creatine kinase CK （CK-MB） were （68±20）, （35±13） and （15.1±4.0） U/L after chemotherapy respectively, which were significantly higher than those before chemotherapy [（50±12）, （28±12） and （7.9±2.6） U/L], the differences were statistically significant （t values were 9.721, 5.137 and 18.850 respectively, all P 〈 0.005）.ConclusionThe use of anthracyclines results in the increased risk of ECG abnormalities and myocardial damage in patients with breast cancer, and cardiac dynamic monitoring should be noted during chemotherapy.

关 键 词：乳腺肿瘤 药物疗法 蒽环类 吡柔比星 心脏不良反应 

分 类 号：R737.9[医药卫生—肿瘤]