加味生脉饮对HER-2阳性乳腺癌赫赛汀所致心脏毒性防治作用研究  

Study on the prevention and treatment effect of Jiawei Shengmaiyin on the cardiotoxicity caused by Herceptin in HER-2 positive breast cancer

作　　者：张洋 刘晓菲 朱晴 王楠 ZHANG Yang;LIU Xiaofei;ZHU Qing;WANG Nan(The First Clinical College of Shandong University of Traditional Chinese Medicine/Shandong Co-Innovation Center of Classic TCM formula, Jinan 250335, Shandong, China)

机构地区：[1]山东中医药大学第一临床医学院/山东省中医经典名方协同创新中心,山东济南250335

出　　处：《现代中西医结合杂志》2020年第24期2640-2643,2683,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：山东省中医经典名方协同创新中心开放课题(2018KFY10);2018年第六批全国老中医药专家学术经验传承(国中医药人教发〔2017〕29号);国家自然科学基金资助项目(81403408)。

摘　　要：目的探讨加味生脉饮对HER-2阳性乳腺癌术后患者赫赛汀靶向治疗后心脏毒性的防治作用。方法选取2018年3月—2019年3月山东中医药大学附属医院山东省中医院收治的HER-2阳性乳腺癌术后患者60例,随机分为对照组、实验组各30例。对照组给予赫赛汀治疗,21 d为1个周期;实验组赫赛汀治疗同对照组,每个周期靶向治疗前3 d口服加味生脉饮,连服14 d。于靶向治疗前和治疗3个周期、6个周期后对2组患者中医症状进行评分,超声检查心脏左室射血分数(LVEF),检测血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)水平,记录心脏毒性事件和心肌酶谱异常率。结果2组治疗3个周期后中医症状积分均明显高于靶向治疗前(P均<0.05),但2组间比较差异无统计学意义(P>0.05);对照组治疗6个周期后中医症状积分明显高于治疗3个周期后和同期实验组(P均<0.05)。2组治疗3个周期、6个周期后LVEF均明显低于靶向治疗前(P均<0.05),且治疗6个周期后明显低于治疗3个周期后(P均<0.05);治疗3个周期、6个周期后实验组LVEF均明显高于对照组(P均<0.05)。对照组治疗3个周期、6个周期后血清CK、CK-MB、LDH水平均明显高于靶向治疗前(P均<0.05),且治疗6个周期后明显高于治疗3个周期后(P均<0.05);实验组治疗3个周期、6个周期后血清CK-MB、LDH水平均明显高于靶向治疗前(P均<0.05),但治疗6个周期后血清CK-MB、LDH水平均明显低于同期对照组(P均<0.05)。对照组3例(10.0%)、实验组1例(3.3%)出现心脏毒性事件,实验组明显低于对照组(P<0.05);实验组治疗3个周期、6个周期后心肌酶谱异常率均明显低于对照组(P均<0.05)。结论加味生脉饮能够改善HER-2阳性乳腺癌术后患者赫赛汀靶向治疗的临床症状,抑制LVEF下降,保护心肌,提高患者对赫赛汀所致心脏毒性的耐受力,预防心脏毒性事件发生。Objective It is to investigate the prevention and treatment effect of Jiawei Shengmaiyin on cardiotoxicity in patients with HER-2 positive breast cancer after Herceptin targeted therapy.Methods Sixty patients with HER-2 positive breast cancer who were admitted to Shandong Provincial Hospital of Traditional Chinese Medicine from March 2018 to March 2019 were randomly divided into control group and experimental group with 30 cases in each group.The control group was treated with Herceptin for 21 days for 1 cycle;the experimental group was treated with Herceptin the same as the control group,and was treated with Jiawei Shengmaiyin at 3 days before each cycle of targeted therapy for 14 days.Before targeted therapy and after 3 cycles and 6 cycles of treatment,the scores of TCM symptoms of the patients were evaluated in the two groups,the left ventricular ejection fraction(LVEF)was examined by ultrasound,and the levels of serum creatine kinase(CK),creatine kinase isozyme(CK-MB),lactate dehydrogenase(LDH)were detected,cardiotoxic events and abnormal rates of myocardial enzyme spectrum were recorded.Results The TCM symptom scores of the two groups after 3 cycles of treatment were significantly higher than those before targeted therapy(P<0.05),but there was no significant difference between the two groups(P>0.05);the TCM symptom scores in the control group after treated for 6 cycles were significantly higher than those after treated for 3 cycles and in the experimental group at the same period(P<0.05).The LVEF in the two groups after 3 cycles and 6 cycles of treatment was significantly lower than that before targeted therapy(all P<0.05),and the lVEF after 6 cycles of treatment was significantly lower than that after 3 cycles of treatment(all P<0.05);the LVEF of the experimental group was significantly higher than that of the control group after 3 cycles and 6 cycles of treatment(all P<0.05).The levels of serum CK,CK-MB,and LDH in the control group after 3 cycles and 6 cycles of treatment were significantly higher than tho

关 键 词：HER-2阳性乳腺癌 赫赛汀靶向治疗 心脏毒性 加味生脉饮 

分 类 号：R737.9[医药卫生—肿瘤]