化疗前心脏代谢指数对乳腺癌患者化疗心脏毒性的预测价值  

Predictive value of pre-chemotherapy cardiometabolic index for chemotherapy-induced cardiotoxicity in breast cancer patients

作　　者：向辉 贾晓斌[1] 柯贤锋 王曦煜 李强[1] 雷珍珍 文小强 Xiang Hui;Jia Xiaobin;Ke Xianfeng;Wang Xiyu;Li Qiang;Lei Zhenzhen;Wen Xiaoqiang(Department of Breast and Thyroid Surgery,Shangluo Central Hospital,Shangluo Shaanxi 726000,China;Department of Breast Surgery,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710000,China;Department of Oncology and Breast Surgery,The Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang Shaanxi 712000,China)

机构地区：[1]陕西省商洛市中心医院乳腺甲状腺外科,陕西商洛726000 [2]西安交通大学第一附属医院乳腺外科,西安710000 [3]陕西中医药大学第二附属医院肿瘤乳腺外科,陕西咸阳712000

出　　处：《保健医学研究与实践》2024年第12期56-62,共7页Health Medicine Research and Practice

基　　金：陕西省卫生健康科研基金项目(2018C006)。

摘　　要：目的探讨化疗前心脏代谢指数(CMI)对乳腺癌患者化疗心脏毒性的预测价值。方法选取2022年6月—2023年12月在商洛市中心医院接受蒽环类化疗药物治疗的281例乳腺癌术后患者作为研究组,同时选取同期于医院体检的200例健康女性作为对照组。根据患者化疗后心脏毒性发生情况,将281例乳腺癌患者分为非心脏毒性组(213例)与心脏毒性组(68例)。采用生化分析仪检测甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C),通过软尺测量腰围(WC),立式身高计测量身高,并计算CMI;采用受试者工作特征(ROC)曲线分析CMI对心脏毒性的预测价值;采用多因素logistic回归分析探讨乳腺癌患者化疗心脏毒性的影响因素。结果研究组TG、CMI水平高于对照组,HDL-C水平低于对照组,差异均有统计学意义(P<0.05)。心脏毒性组患者TG、CMI水平高于非心脏毒性组,HDL-C水平低于非心脏毒性组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,TG、HDL-C、CMI预测乳腺癌患者化疗心脏毒性的曲线下面积(AUC)分别为0.724(95%CI:0.679~0.774)、0.847(95%CI:0.802~0.897)和0.925(95%CI:0.880~0.975),CMI的预测效能更高。心脏毒性组乳腺癌患者脑钠肽(BNP)水平高于非心脏毒性组,左室射血分数(LVEF)水平低于非心脏毒性组,差异有统计学意义(P<0.05)。logistic逐步回归分析结果显示,BNP≥39.73 pg/mL(OR=2.168,95%CI:1.250~3.761),LVEF<48.10%(OR=2.368,95%CI:1.320~4.246),TG≥2.59 mmol/L(OR=2.846,95%CI:1.559~5.195),HDL-C<1.24 mmol/L(OR=2.606,95%CI:1.523~4.460),CMI≥1.06(OR=3.452,95%CI:2.054~5.803)是乳腺癌患者化疗后发生心脏毒性的危险因素(P<0.05)。结论化疗前CMI高水平是乳腺癌化疗心脏毒性的危险因素,可用于预测乳腺癌患者化疗过程中心脏毒性的发生。Objective To study the predictive value of pre-chemotherapy cardiometabolic index(CMI)for chemotherapy-induced cardiotoxicity in breast cancer patients.Methods From June 2022 to December 2023,281 postoperative breast cancer patients treated with anthracycline chemotherapy at Shangluo Central Hospital were selected as the study group,and 200 healthy women who underwent physical examination during the same period were chosen as the control group.The 281 breast cancer patients were assigned to a non-cardiotoxicity group(213 cases)and a cardiotoxicity group(68 cases)based on the occurrence of cardiotoxicity after chemotherapy.Serum triglyceride(TG)and high-density lipoprotein cholesterol(HDL-C)were meas-ured using a biochemical analyzer,waist circumference(WC)was measured with a tape measure,and height was measured with a height meter to calculate CMI.The receiver operating characteristic(ROC)curve was employed to analyze the predictive value of CMI for cardiotoxicity,and multivariate logistic regression was applied to explore the influencing factors of chemother-apy-induced cardiotoxicity in breast cancer patients.Results The study group had significantly higher TG and CMI levels but lower HDL-C level than the control group(P<0.05).The cardiotoxicity group showed significantly higher TG and CMI levels but lower HDL-C level than the non-cardiotoxicity group(P<0.05).ROC curve analysis indicated that the area under the curve(AUC)for predicting chemotherapy-induced cardiotoxicity by TG,HDL-C,and CMI was 0.724(95%CI:0.679-0.774),0.847(95%CI:0.802-0.897),and 0.925(95%CI:0.880-0.975),respectively,suggesting that CMI had the highest predictive efficacy.The cardiotoxicity group had significantly higher BNP levels and lower LVEF levels than the non-cardiotoxicity group(P<0.05).Logistic regression analysis revealed that BNP≥39.73 pg/mL(OR=2.168,95%CI:1.250-3.761),LVEF<48.10%(OR=2.368,95%CI:1.320-4.246),TG≥2.59 mmol/L(OR=2.846,95%CI:1.559-5.195),HDL-C<1.24 mmol/L(OR=2.606,95%CI:1.523-4.460),and CMI≥1.06(OR=3.452,95%CI:2.0

关 键 词：乳腺癌 心脏代谢指数 化疗 心脏毒性 预测价值 

分 类 号：R737.9[医药卫生—肿瘤]