蒽环类抗肿瘤药物的心脏毒性及其防治分析  

Cardiac toxicity of anthracycline antineoplastic drugs and its prevention and treatment

作　　者：张艳蕊 ZHANG Yan-rui(Third Department of Internal Medicine, Fengning Man Nationality Autonomous County Hospital, Chengde, Hebei, 068350, China)

机构地区：[1]承德市丰宁满族自治县医院内三科,河北承德068350

出　　处：《心血管康复医学杂志》2019年第2期207-211,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究在肿瘤治疗中使用蒽环类药物的心脏毒性及其防治措施。方法:选择2014年1月-2015年1月在我院进行抗肿瘤治疗的患者160例作为研究对象。根据使用的蒽环类抗肿瘤药物累积量(ANTH),患者被分为高ANTH组(ANTH>100mg/m^2,110例)和低ANTH组(ANTH≤100mg/m^2, 50例),两组均治疗24个月。比较两组患者治疗前后的心肌肌钙蛋白I(cTnI)、肌酐激酶同工酶(CK-MB)、脑钠肽(BNP)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)。结果:两组患者的cTnI和CK-MB水平的变化无显著差异,P均>0.05。与低ANTH组相比,高ANTH组治疗24个月后的BNP水平[(41.2±15.1)ng/ml比(46.9±15.2)ng/ml]、LVEDd [(32.8±4.3)mm比(34.6±4.6)mm]及LVESd[(21.4±2.6)mm比(22.7±3.4)mm]显著升高,而LVEF[(71.5±5.7)%比(65.7±7.1)%]及LVFS[(38.9±4.6)%比(37.2±4.2)%]均显著降低,P<0.05或<0.01。治疗前后BNP水平与LVEF、LVFS不存在显著相关性(P均>0.05)。结论:蒽环类抗肿瘤药物会引起患者心脏毒性的产生或发展,使患者的BNP水平显著升高,LVEF水平显著降低,因此,应采取一定的防治措施减少其对患者心脏产生的不良影响。Objective: To study cardiac toxicity of anthracycline antineoplastic drugs and its preventive and therapeutic measures. Methods: A total of 160 patients undergoing anti-tumor treatment in our hospital from Jan 2014 to Jan 2015 were enrolled. According to accumulated dose of anthracycline (ANTH), patients were divided into high ANTH group (ANTH>100mg/m 2 , n=110) and low ANTH group (ANTH≤100mg/m 2 , n=50), both groups were treated for 24 months. Levels of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-diastolic diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) were measured and compared between two groups before and after treatment. Results: There were no significant differences in levels of cTnI and CK-MB between the two groups, P >0.05 both. Compared with low ANTH group after 24-month treatment, there were significant rise in BNP level [(41.2±15.1)ng/ml vs.(46.9±15.2)ng/ml], LVEDd [(32.8±4.3)mm vs.(34.6±4.6)mm] and LVESd [(21.4±2.6) mm vs.(22.7±3.4)mm], and significant reductions in LVEF[(71.5±5.7)% vs.(65.7±7.1)%] and LVFS [(38.9±4.6)% vs.(37.2±4.2)%] in high ANTH group, P <0.05 or <0.01. There was no significant correlation among BNP level, LVEF and LVFS before and after treatment ( P >0.05 all). Conclusion: Anthracycline antineoplastic drugs can induce cardiac toxicity or make it develop, so significantly increase BNP level and reduce LVEF in patients. Therefore, certain preventive measures should be performed to reduce its adverse effects on heart.

关 键 词：心脏毒素类 蒽环类 抗肿瘤药 

分 类 号：R979.1[医药卫生—药品]