氟尿嘧啶治疗致急性冠状动脉综合征的诊断学特征并文献复习  

Diagnostic features and literature review of acute coronary syndrome induced by fluorouracil

作　　者：王春晖 李静 吴薇 林瑾仪 许宇辰 吕迁洲 程蕾蕾 Wang Chunhui;Li Jing;Wu Wei;Lin Jinyi;Xu Yuchen;Lyu Qianzhou;Cheng Leilei(Department of Pharmacy,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Echocardiography,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]复旦大学附属中山医院心内科,上海200032 [3]复旦大学附属中山医院心脏超声诊断科,上海200032

出　　处：《中华诊断学电子杂志》2019年第3期151-154,共4页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：国家自然科学基金面上项目(81771840);上海市卫生系统优秀人才培养计划(2017BR027)

摘　　要：目的探讨氟尿嘧啶治疗致急性冠状动脉综合征的诊断学特征。方法回顾性分析1例因结肠癌于复旦大学附属中山医院肿瘤科治疗,氟尿嘧啶化疗后出现急性冠状动脉综合征患者的临床资料,并复习相关文献。结果患者男性,60岁,为合并冠心病行经皮冠状动脉介入治疗的结肠癌患者,行辅助化疗FOLFOX(氟尿嘧啶、亚叶酸钙、奥沙利铂)方案,第1周期第14天出现胸闷、持续性胸部隐痛,平卧不能,端坐呼吸,气稍促。血清心肌肌钙蛋白T(cTnT)(0.687μg/L),氨基末端利钠肽前体(NT-proBNP)(7 128 ng/L)水平均显著升高;心电图呈持续性心肌缺血改变;肺动脉CT血管造影未见明确栓塞征象。排除其他病理因素和药物因素可能,考虑为氟尿嘧啶治疗致急性冠状动脉综合征。经对症支持治疗后心肌细胞损伤标志物水平逐渐下降,患者未再诉胸闷、胸痛症状。改予TOMOX(奥沙利铂、雷替曲塞)方案,化疗期间和化疗后定期随访,心电图、经胸超声心动图较之前无明显变化,cTnT水平逐渐降低至正常值。结论氟尿嘧啶化疗患者应密切监测其心脏毒性如急性冠状动脉综合征的发生,保障患者化疗顺利进行。Objective To explore the diagnostic features of acute coronary syndrome induced by fluorouracil.Methods A case of acute coronary syndrome after fluorouracil chemotherapy who was treated for colon cancer in the oncology department of Zhongshan Hospital Affiliated to Fudan University was retrospectively analyzed,the relevant literatures were reviewed.Results A 60-year-old male colon cancer patient combined with coronary heart disease who underwent percutaneous coronary intervention accepted the first cycle adjuvant chemotherapy FOLFOX(fluorouracil,calcium folinate,oxaliplatin)regimen.On the 14 th day after chemotherapy,he developed chest tightness,persistent chest pain,inability to lie flat,sitting breathing and shortness of breath.Both serum cardiac troponin(cTnT)level(0.687μg/L)and N-terminal pro B-type natriuretic(NT-proBNP)level(7 128 ng/L)increased significantly,ECG revealed persistent myocardial ischemia changes and pulmonary CTA showed no definite embolism signs.Excluding other pathological and drug factors,acute coronary syndrome caused by fluorouracil was considered.After the symptomatic supportive treatment,the levels of cTnT and NT-proBNP reduced gradually while the patient no longer complained of chest tightness or chest pain.The surveillance of ECG and TTE during and after TOMOX(oxaliplatin,raltitrexed)regimen had no difference and the level of cTnT decreased to the normal.Conclusion Patients receiving fluorouracil should be monitored carefully of drug-induced cardiotoxicity,such as acute coronary syndrome,to ensure the smooth progress of chemotherapy.

关 键 词：氟尿嘧啶 化疗方法 辅助 急性冠状动脉综合征 冠心病 结肠肿瘤 

分 类 号：R730.5[医药卫生—肿瘤] R541.4[医药卫生—临床医学]