曲妥珠单抗联合化疗致人表皮生长因子受体2阳性乳腺癌患者心脏毒性的影响因素分析  

An analysis of factors influencing cardiotoxicity in patients with HER-2-positive breast cancer induced by trastuzumab plus chemotherapy

作　　者：陈永刚[1] 赵恒毅 孙雯霏 CHEN Yonggang;ZHAO Hengyi;SUN Wenfei

机构地区：[1]徐州市中心医院,江苏徐州221009

出　　处：《中医临床研究》2024年第6期101-105,共5页Clinical Journal Of Chinese Medicine

摘　　要：目的:探讨曲妥珠单抗联合化疗致人表皮生长因子受体2(Human Epidermal Growth Factor Receptor-2,HER-2)阳性乳腺癌患者心脏毒性的影响因素。方法:选取2020年12月-2022年12月徐州市中心医院诊治的152例HER-2阳性乳腺癌患者为研究对象。所有患者均采用曲妥珠单抗联合化疗(AC→PH)方案治疗,治疗期间每3个月使用超声监测心功能,统计心脏毒性发生情况。收集患者的临床资料,包括年龄、体质量指数、肿瘤分期、合并症(高血压病、糖尿病、高脂血症)、雌激素受体(Estrogen Receptor,ER)/孕激素受体(Progesterone Receptor,PR)的表达情况、吸烟史、饮酒史、同期行放疗及右丙亚胺使用情况,采用单因素分析、多因素Logistic回归分析患者发生心脏毒性的危险因素。结果:152例患者中心脏毒性发生率为26.31%,发生心脏毒性的患者常见的心电图改变有:T波改变、窦性心率过缓/过速、ST段异常等。单因素分析显示,年龄≥60岁、合并高血压病、合并高脂血症、同期行放疗、联合使用右丙亚胺是发生心脏毒性的影响因素(P <0.05)。多因素Logistic回归分析显示,年龄[95%置信区间(CI):2.429~5.135]、合并高血压病(95%CI:1.625~3.962)、合并高脂血症(95%CI:2.054~5.362)、同期行放疗(95%CI:1.759~4.637)是曲妥珠单抗联合化疗致HER-2阳性乳腺癌患者心脏毒性的危险因素(P<0.05),而联合使用右丙亚胺(95%CI:3.772~6.015)可显著减少心脏毒性的发生(P <0.05)。结论:年龄≥60岁、合并高血压病/高脂血症、同期行放疗是曲妥珠单抗联合化疗致HER-2阳性乳腺癌患者心脏毒性发生的危险因素,使用右丙亚胺是HER-2阳性乳腺癌患者发生心脏毒性的保护因素;化疗期间应将年龄≥60岁、合并高血压病和高脂血症、同期行放疗的患者列为心脏毒性的重点防治人群,联合应用右丙亚胺有助于减少心脏毒性发生。Objective:To investigate the factors influencing cardiotoxicity in human epidermal growth factor receptor 2(HER-2)-positive breast cancer patients induced by trastuzumab combined with chemotherapy.Methods:A total of 152 patients with HER-2-positive breast cancer diagnosed and treated in Xuzhou Central Hospital from December 2020 to December 2022 were selected as the study subjects.All the patients were treated with trastuzumab plus chemotherapy(AC→PH)regimen.Ultrasound was used to monitor cardiac function every 3 months during treatment,and the incidence of cardiotoxicity was recorded.Clinical data of the patients was collected,including age,body mass index,tumor stage,complications(hypertension,diabetes,hyperlipidemia),estrogen receptor(ER)/progesterone receptor(PR)expression,smoking history,drinking history,concurrent radiotherapy and dextropropimide use.The risk factors of cardiotoxicity were analyzed by univariate analysis and multivariate logistic regression.Results:Among the 152 patients,the incidence of cardiotoxicity was 26.31%.The common ECG changes in patients with cardiotoxicity included T-wave changes,sinus bradycardia/tachycardia,and ST segment abnormalities.Univariate analysis showed that not less than 60 years old,complicated with hypertension,complicated with hyperlipidemia,concurrent radiotherapy,combined use of dexrazoxane were the influencing factors of cardiotoxicity(P<0.05).Multivariate logistic regression analysis showed that age(95%CI:2.429-5.135),complicated with hypertension(95%CI:1.625-3.962),complicated with hyperlipidemia(95%CI:2.054-5.362),concurrent radiotherapy(95%CI:1.759-4.637)were risk factors for cardiotoxicity due to trastuzumab plus chemotherapy in patients of breast cancer with positive HER-2(P<0.05),while the combination of dexrazoxane(95%CI:3.772-6.015)significantly reduced the incidence of cardiotoxicity(P<0.05).Conclusion:Not less than 60 years old,complicated with hypertension or hyperlipidemia,and concurrent radiotherapy are risk factors for cardiotoxicity in patients

关 键 词：曲妥珠单抗 化疗 人表皮生长因子受体2阳性乳腺癌 心脏毒性 因素分析 

分 类 号：R273[医药卫生—中西医结合]