抗肿瘤药物致心脏毒性41例临床分析  

Analysis of 41 cases of cardiotoxicity caused by antitumor drugs

作　　者：邰宵辉 李红玲[1] 党春艳 张玲芳[1] 张旭霞[1] 薛丽[1] 刘乐[1] TAI Xiao-hui;LI Hong-ling;DANG Chun-yan;ZHANG Ling-fang;ZHANG Xu-xia;XUE Li;LIU Le(Gansu Provincial People’s Hospital,Department of Medical Oncology,Lanzhou 730013,China)

机构地区：[1]甘肃省人民医院肿瘤内科,甘肃省兰州市730013

出　　处：《中国心血管病研究》2022年第5期422-426,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金项目(81760537、81560498);甘肃省科技厅国际合作项目(20YF8WA096);甘肃省人民医院院内科研基金项目(18GSSY4-30)。

摘　　要：目的分析恶性肿瘤治疗过程中抗肿瘤药物致心脏毒性反应的临床特点,为临床防治抗肿瘤药物致心脏毒性提供合理用药及治疗参考。方法选取甘肃省人民医院肿瘤内科2020年1月至12月恶性肿瘤患者,包括性别、年龄、原发肿瘤类型、抗肿瘤药物种类、剂量强度、治疗周期。随访0.6~23.4个月(中位随访时间12.8个月)。观察终点为患者出现心脏毒性发生时间及表现、治疗后转归情况。结果恶性肿瘤患者共426例,平均治疗时间4个月,41例患者抗肿瘤期间出现心脏毒性,占9.6%,其中心律失常患者27例,心功能不全5例,高血压5例,心肌梗死3例,心包积液1例;抗肿瘤药物联合应用者37例(91.2%);用药周期大于4个月者32例(78%);原发肿瘤以淋巴瘤最多见,占41.5%(17/41),其次是结直肠肿瘤(22%,9/41)和肺癌(14.6%,6/41);前3位的治疗方案分别为:含蒽环类方案的化疗、氟尿嘧啶类药物方案以及VEGF(血管内皮生长因子)抑制剂。结论心脏毒性作为抗肿瘤药物治疗过程中的常见不良反应,与抗肿瘤治疗时间、强度及使用药物类型有明确关系,多种抗肿瘤药物联合应用更易发生心脏损害,治疗过程中,应该以患者的承受能力选取相应抗肿瘤药物治疗方案从而做到获益最大化。Objective To explore the clinical characteristics of the cardiotoxicity induced by anti-tumor drugs during the treatment of malignant tumors and provide rational drug use and treatment reference for the prevention and treatment.Methods Patients with malignant tumors from January to December 2020 in the Department of Medical Oncology,Gansu Provincial People’s Hospital were selected and the gender,age,primary tumor type,type of antitumor drugs,dose intensity and treatment cycle were recorded.The follow-up period ranged from 0.6 to 23.4 months(median follow-up time was 12.8 months).The observation end point was the occurrence time and manifestation of cardiotoxicity,and the outcome after treatment.Results Among the 426patients with malignant tumors,with an average treatment time of 4 months,41 patients had cardiotoxicity during the anti-tumor period,accounting for 9.6%of the total number,including 27 cases with arrhythmia,5 cases with cardiac insufficiency,5 cases with hypertension,3 cases with myocardial infarction,and 1 case with pericardial effusion.37 cases(91.2%)were treated with combined antitumor drugs.32 cases(78%)were treated over 4months.Lymphoma was the most common primary tumor,accounting for 41.5%(17/41),followed by colorectal tumor(22%,9/41)and lung cancer(14.6%,6/41).The top three options were chemotherapy with anthracyclines,fluorouracil regimens and VEGF inhibitors.Conclusion Cardiotoxicity is a common adverse reaction in the use of anti-tumor drugs.The combination of various anti-tumor drugs is more prone to the heart damage.The corresponding anti-tumor drug treatment scheme should be selected according to the patient’s bearing capacity to maximize the benefits.

关 键 词：抗肿瘤药物 心脏毒性 临床分析 

分 类 号：R54[医药卫生—心血管疾病]