右丙亚胺对表柔比星方案化疗乳腺癌患者表柔比星心脏毒性的预防作用观察  

Exploration of preventive effect of dexrazoxane on epirubicin-induced cardiotoxicity in breast cancer patients

作　　者：杨孟达 张鹏程 张迅 赵晶晶 张也 晏大学 YANG Mengda;ZHANG Pengcheng;ZHANG Xun;ZHAO Jingjing;ZHANG Ye;YAN Daxue(Postgraduate Training Base,Xiangyang No.1 People's Hospital,Affiliated Hospital of Hubei University of Medicine,Jinzhou Medical University,Xiangyang 441000,China)

机构地区：[1]锦州医科大学湖北医药学院附属襄阳市第一人民医院研究生培养基地,湖北襄阳441000

出　　处：《山东医药》2022年第15期38-43,共6页Shandong Medical Journal

摘　　要：目的探讨右丙亚胺对乳腺癌患者使用表柔比星化疗引发的心脏毒性的预防作用。方法乳腺癌患者90例,随机分为观察组及对照组各45例,两组均采用表柔比星方案(EC-T,前4个治疗周期静脉滴注50 mg/m^(2)盐酸表柔比星联合500 mg/m^(2)环磷酰胺,后4个治疗周期静脉滴注75 mg/m2序贯多西他赛,共8个治疗周期,每21天为1个治疗周期)化疗。观察组患者使用EC-T方案前30 min快速静脉滴注右丙亚胺,与表柔比星剂量比为10∶1。两组患者第1、3、5、8治疗周期前1 d与化疗后3 d,均采用ELISA法检测天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH),心脏彩超测量左心室射血分数(LVEF),并行心电图(ECG)检查。结果每个治疗周期前后,对照组各心肌酶均高于治疗前(P均<0.05);每个治疗周期结束后,对照组各心肌酶均高于第1个治疗周期治疗前(P均<0.05),LVEF均低于第1个治疗周期化疗前,但仅第3、5个治疗周期差异有统计学意义(P均<0.05)。每个治疗周期后,除AST指标降低以外,观察组其他心肌酶均高于治疗前,但差异无统计学意义(P均>0.05);每个治疗周期结束后,观察组心肌酶均高于第1个治疗周期治疗前,但差异无统计学意义(P均>0.05);化疗前观察组第3个治疗周期CK、CK-MB及第5个治疗周期CK低于对照组(P均<0.05);化疗后观察组第1个治疗周期AST、LDH、CK,第3个治疗周期AST、LDH、CK、CK-MB,第5个治疗周期AST、α-HBDH、CK、CK-MB以及第8个治疗周期AST均低于对照组(P均<0.05)。每个治疗周期结束后,观察组LVEF均低于第1个治疗周期化疗前,但差异均无统计学意义(P均>0.05);化疗后观察组LVEF高于对照组,但差异无统计学意义(P>0.05);观察组每个治疗周期结束后心脏彩超、心电图异常率均低于对照组(P均<0.05)。结论右丙亚胺对乳腺癌患者使用表柔比星化疗引发的心脏毒性有一�Objective To investigate the preventive effect of dexrazoxane on cardiotoxicity induced by chemotherapy with epirubicin in breast cancer patients.Methods Ninety patients with breast cancer were randomly divided into the ob⁃servation group and control group,with 45 patients in each.Patients in both groups were treated with chemotherapy using the epirubicin regimen(The EC-T regimen was that 50 mg/m2 epirubicin hydrochloride combined with 500 mg/m2 cyclo⁃phosphamide were administered intravenously for the first 4 treatment cycles,and 75 mg/m2 sequential docetaxel was ad⁃ministered intravenously for the last 4 treatment cycles;every 21 days was a treatment cycle,for a total of 8 treatment cy⁃cles).Patients in the observation group were given a rapid intravenous dose of dexrazoxane 30 min prior to the EC-T regi⁃men in a 10:1 dose ratio with epirubicin,while patients in the control group were not given dexrazoxane.The levels of as⁃partate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CKMB)andα-hydroxybutyrate dehydrogenase(α-HBDH)were measured by ELISA,and the left ventricular ejection fraction(LVEF)was measured by cardiac ultrasound as well as electrocardiography(ECG)at 1 d before the first,third,fifth and eighth cycles of chemotherapy and at 3 d after chemotherapy in both groups.Results Before and after each treatment cy⁃cle,cardiac enzyme in the control group was higher than that before treatment(P<0.05);after the end of each treatment cycle,cardiac enzyme in the control group was higher than that before the 1st cycle of treatment(P<0.05),and LVEF was lower than that before chemotherapy in the 1st treatment cycle,but the difference was statistically significant only between the 3rd and 5th treatment cycles(P<0.05).Before and after each treatment cycle,except for the reduction of AST index,all other cardiac enzymes in the observation group were higher than those before treatment,but the statistical significance was not significant(P>0.05);after the end

关 键 词：右丙亚胺 化疗药物毒性作用 化疗药物心脏毒性 蒽环类药物不良作用 表柔比星 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤]