乳腺癌患者蒽环类续贯曲妥珠单抗治疗期间超声心动图监测执行度分析  

Echocardiographic monitoring during medication with trastuzumab following treatment of breast cancer patients with anthracyclines

作　　者：董百惠 姜红[2] 肖响 付东亮[2] 李春岩[2] DONG Baihui;JANG Hong;XIAO Xiang;FU Dongliang;LI Chunyan(Department of Pharmacy,Yantai Hospital of Traditional Chinese Medicine,Yantai Shandong 264013,China;Department of Integrative Cardiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]烟台市中医医院药学部,山东烟台264013 [2]中日友好医院中西医结合心脏科,北京100029

出　　处：《中国药物警戒》2022年第5期557-560,共4页Chinese Journal of Pharmacovigilance

摘　　要：目的回顾性研究人类表皮生长因子受体2(Her-2)阳性早期乳腺癌患者使用蒽环类药物续贯曲妥珠单抗治疗期间的超声心动图检测情况、左心室收缩功能障碍发生率,为蒽环类药物续贯曲妥珠单抗合理使用提供参考。方法收集2016年7月1日至2019年12月31日某三甲医院使用蒽环类药物续贯曲妥珠单抗治疗的Her-2阳性早期乳腺癌住院患者超声心动图检测结果,统计分析蒽环类药物用药前(T1)、曲妥珠单抗用药前(T2)、曲妥珠单抗治疗过程中(T3)、曲妥珠单抗治疗结束时(T4)超声心动图检测率及T3检测次数,以及左心室射血分数(LVEF)变化等。结果60例符合纳排标准的乳腺癌患者中,T1、T2、T3、T4超声心动图检测率分别为15.00%、58.33%、51.67%、11.67%,T3超声心动图检测次数构成比分别为41.94%(检测1次)、25.81%(检测2次)、29.03%(检测3次)、3.23%(检测4次)。与治疗前相比,治疗后LVEF值无明显下降(P>0.05),但是在曲妥珠单抗使用期间LVEF有所下降(P<0.05),但下降程度不足10%,未达到心脏毒性诊断标准。结论临床中蒽环类药物续贯曲妥珠单抗治疗期间未能完全遵循指南和药品说明书监测左心室收缩功能,存在一定的安全隐患。Objective To investigate the results of echocardiographic detection and the incidence of left ventricular systolic dysfunction during medication with trastuzumab following treatment with anthracyclines in patients with human epidermal growth factor receptor 2(HER-2)positive early-stage breast cancer,and to provide reference for rational drug use.Methods The results of echocardiographic detection of patients with early-stage breast cancer treated with trastuzumab following anthracyclines in a big hospital between July 1,2016 and December 31,2019 were collected.At baseline(T1),before administration of anthracycline(T2),during trastuzumab administration(T3)and when trastuzumab therapy was finished(T4),the detection rate of echocardiography,the number of times of echocardiographic detection at T3 and the changes of left ventricular ejection fraction(LVEF)were analyzed.Results Among the 60 patients with breast cancer who met the inclusion and exclusion criteria,15.00%,58.33%,51.67% and 11.67% underwent echocardiographic detection at T1,T2,T3 and T4.At T3,the composition ratio of the number of times of echocardiography detection was 41.94%(once),25.81%(twice),29.03%(three times)and 3.23%(four times)respectively.There was no significant decrease in LVEF(P<0.05)after treatment,However,LVEF decreased when trastuzumab was used(P>0.05),but by less than 10%.Its damage to the heart was below the diagnostic criteria of cardiotoxicity.Conclusion Failure to effectively monitor the left ventricular systolic function during medication with trastuzumab following the anthracyclines therapy may pose a risk to the safety of patients.

关 键 词：乳腺癌 蒽环类药物 曲妥珠单抗 心脏毒性 超声心动图 

分 类 号：R916.696[医药卫生—药学]