心率减速力在曲妥珠单抗治疗乳腺癌相关心脏毒性的预测价值  

The predictive value of deceleration capacity of rate on trastuzumab⁃related cardiotoxicity in the treatment of breast cancer

作　　者：俸艳英[1] 阳志军[2] FENG Yanying;YANG Zhijun(Cardiopulmonary Center,Guangxi Medical University Cancer Hospital,Nanning 530021,China;不详)

机构地区：[1]广西医科大学附属肿瘤医院心肺功能中心,南宁530021 [2]广西医科大学附属肿瘤医院妇瘤科,南宁530021

出　　处：《实用医学杂志》2021年第1期66-70,共5页The Journal of Practical Medicine

基　　金：广西卫生与计划生育委员会自筹课题项目(编号:Z2015600);广西医学高层次骨干人才培养“139”计划项目(编号:桂卫科教发[2018]22号)。

摘　　要：目的探讨心率减速力(deceleration capacity of heart rate,DC)预测曲妥珠单抗辅助治疗人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性乳腺癌所致心脏毒性的临床应用价值。方法回顾性研究2015年6月至2017年6月在我院接受曲妥珠单抗辅助治疗HER2阳性乳腺癌患者。用药前通过24 h动态心电图检测计算DC和超声心动图测量左心室射血分数(left ventricular ejection fraction,LVEF)评估心脏功能基线水平。用药期间及用药结束后有定期随访心脏毒性相关临床症状及检测LVEF完整资料。结果符合入组患者150例,其中28例(18.7%)出现心脏毒性。与无心脏毒性组相比,有心脏毒性组的年龄较大(P=0.018)、蒽环类药物治疗剂量更高(P<0.001)、治疗前的DC和LVEF较低(P<0.001)。Logistic回归分析结果显示,蒽环类药物高治疗剂量、治疗前较低的DC及LVEF是曲妥珠单抗相关心脏毒性的独立危险因素。受试者工作特征(ROC)分析显示,DC的曲线下面积比基线LVEF大(0.875 vs.0.763,P=0.032)。结论DC在曲妥珠单抗相关心脏毒性中有早期预测作用。Objective Early predictors of trastuzumab⁃related cardiotoxicity are urgently needed.There⁃fore,we investigated the clinical value of the deceleration capacity of the heart rate(DC)in predicting trastuzumab⁃related cardiotoxicity in the treatment of human epidermal growth factor receptor 2(HER2)⁃positive breast cancer.Methods Patients with HER2⁃positive breast cancer treated with trastuzumab at our hospital from June 2015 to June 2017 were retrospectively observed.DC was assessed before treatment,and the left ventricular ejection fraction(LVEF)was regularly monitored for 2 years(before,during,and after treatment)to evaluate the develop⁃ment of cardiotoxicity.Results Among 150 eligible patients with complete datasets,28(18.7%)developed cardiotoxicity.The age of patients with cardiotoxicity were older(P=0.018),the anthracycline dose they received was higher(P<0.001),and DC and baseline LVEF they had were lower(P<0.001),compared with those in patients without cardiotoxicity.Logistic regression revealed that lower DC,lower baseline LVEF,and higher anthra⁃cycline dose were independent risk factors of trastuzumab⁃related cardiotoxicity.Receiver operating characteristic curve analysis revealed a greater area under the curve for DC than for the baseline LVEF in predicting cardiotoxicity(0.875 vs.0.768,P=0.032).Conclusion DC should be an early predictor of trastuzuma⁃related cardiotoxicity.

关 键 词：乳腺癌 曲妥珠单抗 心脏毒性 心率减速力 左心室射血分数 

分 类 号：R737.9[医药卫生—肿瘤]