氟尿嘧啶类药物治疗头颈部恶性肿瘤所致心脏毒性的分析  

The Study of Cardiotoxicity of Fluorouracil on Patients with Head and Neck Cancer

作　　者：张青 沈永奇 刘文健 黄汉生 斯韬[5] 林海永 孔祥应 ZHANG Qing;SHEN Yong-qi;LIU Wen-jian;HUANG Han-sheng;SI Tao;LIN Hai-yong;KONG Xiang-ying(The Pharmacy Department,Liujiang District People’s Hospital,Liuzhou 545100,China;The Oncology Department,Guangxi Medical University Affiliated Liutie Central Hospital,Liuzhou 545007,China;The Oncology Department,Rongshui County People's Hospital,Liuzhou 545300,China;The Chemotherapy Department,the Second Affiliated Hospital of Guangxi University of Science and Technology,Liuzhou 545001,China;The Oncology Department,the Third Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Liuzhou 545001,China;The Oncology Department,Pingnan Second People’s Hospital,Guigang 537300,China;The Oncology Department,the Third Affiliated Hospital of Guiyang College of Traditional Chinese Medicine,Duyun 558004,China)

机构地区：[1]柳州市柳江区人民医院药剂科,广西柳州545100 [2]广西医科大学附属柳铁中心医院肿瘤科,广西柳州545007 [3]融水县人民医院肿瘤科,广西柳州545300 [4]广西科技大学第二附属医院化疗科,广西柳州545001 [5]广西中医药大学第三附属医院肿瘤科,广西柳州545001 [6]平南县第二人民医院肿瘤科,广西贵港537300 [7]贵阳中医学院第三附属医院肿瘤科,贵州都匀558004

出　　处：《河南医学研究》2020年第9期1552-1556,共5页Henan Medical Research

基　　金：广西壮族自治区卫生健康委员会科研项目(Z20190448)。

摘　　要：目的观察氟尿嘧啶类药物治疗头颈部恶性肿瘤(HNC)所致的心脏毒性。方法将7个肿瘤中心2014年1月至2017年12月接诊的、同意化疗的154例HNC患者,采用前瞻性非随机的方法,按患者意愿采用不同的化疗方案,分为含氟尿嘧啶类药物组(观察组)和不含氟尿嘧啶类药物组(对照组),观察两组心脏毒性的发生率、严重程度及发生心脏毒性时的化疗周期数。结果可评价142例,其中观察组78例(PF方案67例,TPF方案11例),对照组64例(TP方案38例,GP方案26例)。观察组心电图异常发生率高而LVEF减低和心肌酶升高少见。观察组的心电图异常发生率高于对照组,差异有统计学意义(P<0.05)。两组LVEF减低、心肌酶升高的发生率比较,差异无统计学意义(P>0.05)。心电图的异常主要表现为ST-T改变、心律失常和QT间期延长,多数发生在化疗3个周期后且常表现为多种心电图异常同时出现。氟尿嘧啶相关心脏毒性在疾病诊断上最常见的为心肌缺血、心律失常和冠心病,在严重程度上主要为Ⅰ级和Ⅱ级。结论氟尿嘧啶治疗HNC所致的心脏毒性多为轻度,主要表现为心电图的异常,引起心肌供血不足病变及心律失常,而对心肌破坏和射血功能改变较小。Objective To evaluate the cardiotoxicity of fluorouracil on patients with head and neck cancer(HNC).Methods One hundred and fifty-four patients with HNC admitted to 7 cancer center from January 2014 to December 2017,who accept chemotherapy and meet evaluation requirements,were divided into fluorouracil group(observation group)and no fluorouracil group(control group)according to the patient’s wishes.The incidence and severity of cardiotoxicity and duration of chemotherapy in the two groups were evaluated.Results One hundred and forty-two patients can be evaluated,include 78 patients(67 patients of PF regimen and 11 patients of TPF regimen)in the observation group and 64 patients(38 patients of TP regimen and 26 patients of GP regimen)in the control group.In the observation group,incidence of ECG abnormalities was higher,decreased cardiac ejection fraction(LVEF)and increased myocardial enzyme were lower.The total incidence of ECG abnormalities of the observation group was apparently higher than the control group,and the difference was statistically significant(P<0.05).The incidences of decreased LVEF and increased myocardial enzyme of the two groups were no statistically significant difference(P>0.05).Abnormal ECG were mainly manifested as ST-T changes,arrhythmia,and extended QT interval.It was often manifested as a variety of ECG abnormalities occurring simultaneously and most occured after 3 cycles of chemotherapy.Fluorouracil induiced cardiac toxicity on disease diagnosis for the most common myocardial ischemia,arrhythmia and coronary heart disease,mainly in the serious degreeⅠandⅡdegrees.Conclusion The cardiac toxicity of fluorouracil in HNC was often mild.It is mainly manifested in the abnormal changes of ECG,which has obvious effect on myocardial ischemia and arrhythmia,while the changes of myocardial damage and ejection function are relatively small.

关 键 词：头颈部恶性肿瘤 氟尿嘧啶 化疗 心脏毒性 

分 类 号：R739.91[医药卫生—肿瘤]