卡维地洛联合右丙亚胺对乳腺癌应用蒽环类药物引起心脏毒性的保护作用  

Protective effects of carvedilol combined with dexrazoxane against anthracycline-induced cardiomyopathy

作　　者：程冕 杨艺 张存泰[1] 李瑞超 CHENG Mian;YANG Yi;ZHANG Cun-tai;LI Rui-chao(Department of Geriatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院综合医疗科,湖北武汉430030

出　　处：《中国医院药学杂志》2020年第15期1643-1646,共4页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金资助项目(81700355)。

摘　　要：目的:探讨卡维地洛联合右丙亚胺对乳腺癌患者应用蒽环类药物引起心脏毒性的保护作用。方法:选择2017年6月至2018年12月在华中科技大学附属同济医院乳腺癌根治术后接受含蒽环类药物化疗的患者101例。以随机数字表法分为对照组(n=51)和观察组(n=50)。2组患者均接受EC方案8周期,并于化疗前予右丙亚胺预处理,观察组在此基础上加用卡维地洛25 mg,qd,对照组给予安慰剂,qd。化疗前及化疗8周期后采用超声心动图检查检测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左心室舒张早期快速充盈峰与左心房收缩期充盈峰比值(E/A);化学发光法检测心肌损伤标记物血清肌钙蛋白I(cTnI);ELISA法检测炎性标记物血清白细胞介素-1β(IL-1β)、白细胞介素-1(IL-6)。结果:化疗8周期后,2组LVEF、E/A较治疗前均降低(对照组:t=10.84、3.104;观察组:t=4.318、2.109,均为P<0.05);相较于观察组,对照组LVEF、E/A明显降低(t=2.707,P<0.01);2组LVEDD较治疗前均增加(对照组:t=7.482,观察组:t=3.351,均为P<0.01),对照组与观察组对比,LVEDD明显增加(t=4.699,P<0.01)。化疗8周期后,2组cTnI、IL-1β、IL-6较基线水平均明显上升(对照组:t=5.385、4.948、11.82;观察组:t=3.434、3.505、7.664,均为P<0.01),对照组较观察组cTnI、IL-1β、IL-6上升更明显(t=2.265、2.330、4.422,均为P<0.05)。结论:卡维地洛联合右丙亚胺可以降低乳腺癌患者应用蒽环类药物引起的心脏毒性,降低炎性因子IL-1β、IL-6水平。OBJECTIVE To investigate the protective effect of carvedilol combined with dexrazoxane in cardiotoxicity induced by anthracycline in patients with breast cancer.METHODS From June 2017 to December 2018,101 patients with breast cancer received anthracycline-containing chemotherapy after radical mastectomy in Tongji Hospital Affiliated to Huazhong University of Science and Technology were selected.They were randomLy divided into control group(n=51)and observation group(n=50).Both groups received 8 cycles of EC chemotherapy and were pretreated with dextran before chemotherapy.The observation group was treated with carvedilol,25 mg/day.After 8 cycles of chemotherapy,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and left ventricular rapid filling peak to left atrial systolic filling peak ratio(E/A)were measured by echocardiography.Chemiluminescence was used to detect serum troponin I(cTnI),a marker of myocardial injury;ELISA was used to detect serum interleukin-1β(IL-1β)and interleukin-1(IL-6),markers of inflammation.RESULTS After 8 cycles of chemotherapy,the levels of LVEF and E/A in both groups were lower than those before treatment(control group:t=10.84,3.104;observation group:t=4.318,2.109,all P<0.05);the levels of LVEF and E/A in control group were lower than those in observation group(t=2.707,P<0.01);the levels of LVEDD in both groups were higher than those before treatment(control group:t=7.482,observation group:t=3.351,P<0.01).Compared with observation group,LVEDD in control group was significantly increased.(t=4.699,P<0.01).After treatment,the levels of cTnI,IL-1βand IL-6 in the two groups were significantly higher than those in the baseline(control group:t=5.385,4.948,11.82;observation group:t=3.434,3.505,7.664,all P<0.01),while the levels of cTnI,IL-1βand IL-6 in the control group were significantly higher than those in the observation group(t=2.265,2.330,4.422,all P<0.05).CONCLUSION Carvedilol combined with dexrazoxane can reduce anthracycline-induced cardiotoxic

关 键 词：乳腺癌 蒽环类 卡维地洛 右丙亚胺 心脏保护 

分 类 号：R969[医药卫生—药理学]