摘要
目的探讨右丙亚胺（DEX）对乳腺癌患者接受含蒽环类药物化疗时的心脏保护作用。方法选取122例乳腺癌术后患者，随机分为实验组和对照组。实验组61例，在接受含蒽环类药物化疗方案的同时，采用DEX治疗；对照组61例，患者仅采用含蒽环类药物化疗方案。所有患者化疗4个周期，分别监测化疗前后患者的心脏功能状态和血液学变化，观察化疗的非心脏及血液学毒性反应。结果对照组患者化疗前后B型脑利钠肽（BNP）分别为（106．78±4．52）×10^-6μg／ml和（187．19±8．71）×10^-6μg/ml，差异有统计学意义（P〈0．05）；实验组患者化疗前后BNP分别为（102．34±8．76）×10^-6μg／ml和（105．29±7．21）×10^-6μg／ml，差异无统计学意义（P〉0．05）。对照组患者化疗前后心肌肌钙蛋白T（cTnT）分别为（12．55±2．73）×10^-6μg／ml和（31．05±7．10）×10^-6μg／ml，差异有统计学意义（P〈0．05）；实验组患者化疗前后cTnT分别为（12．704-2．15）×10^-3μg／ml和（13．22±7．82）×10^-3μg/ml，差异无统计学意义（P〉0．05）。对照组患者化疗前后心率分别为（75．32±7．14）次／min和（89．60±9．21）次／min，差异有统计学意义（P〈0．05）；实验组患者化疗前后心率分别为（78．60±6．29）次／min和（83．10±7．56）次／min，差异无统计学意义（P〉0．05）；对照组患者化疗前后左室射血分数（LVEF）分别为（65．23±7．82）％和（55．21±7．23）％，差异有统计学意义（P〈0．05）；实验组化疗前后LVEF分别为（64．12±6．25）％和（59．36±4．72）％，差异无统计学意义（P〉0．05）。对照组患者化疗前后中性粒细胞（ANC）计数分别为（3．95±1．36）×10^9／L和（3．50±1．52）X10。／L，差异无统计学意义（P〉0．c15）；实验组化疗前后ANC计数分别为（4．96±1．41）×10^9／L和（3．10±1．26）×10^9／L，差异有统计学意义（P〈0．05）。两组患者非心脏及血液学毒性反应的差异无统计学意义（P〉0．05）。实验组I-Ⅳ度骨髓抑制发生率分别为21．3％、16．4％、24．6％和4．9％。对照组I～Ⅳ度骨髓抑制发生率分别为16．4％、11．5％、9．8％和5．5％，差异有统计学意义（P〈0．05）。结论DEX在不增加乳腺癌患者非心脏及血液学毒性的前提下，可明显降低蒽环类药物化疗患者的心脏毒性。DEX联合蒽环类药物增加了乳腺癌患者骨髓抑制的发生风险，在联合使用时应密切监测患者血象或给予常规骨髓支持。
Objective To evaluate the cardioprotective effects of dexrazoxane （DEX） on breast cancer patients who received anthracycline-containing chemotherapy. Methods A total of 122 breast cancer patients after operation were randomly divided into two groups： The experimental group of 61 cases treated with EPI plus DEX （ DEX： EPI = 10：1 ） as adjuvant chemotherapy regimen, and the control group of 61 cases treated with EPI but without DEX. All patients received four cycles of adjuvant chemotherapy and their changes of specific cardiac functional status and hematology status before and after chemotherapy, as well as non-cardiac toxicity were observed and analyzed. Results Brain natriuretic peptide （BNP） before chemotherapy and after four cycles of chemotherapy in the control group was （ 106.78 ±4.52） ×10^-6μg/ml and （187.19 ± 8.71 ） ×10^-3μg/ml, respectively, with a significant difference between them （P 〈 0.05 ）. It in the experimental group was （ 102.34 ± 8.76） ×10^-6μg/ml and （ 105.29 -± 7.21 ）×10^-3μg/ml, respectively, without a significant difference （P 〉 0.05 ）. Cardiac troponin T （cTnT） before chemotherapy and after four cycles of chemotherapy in the control group was （ 12.55 ±2.73） ×10^-3μg/ml and （ 31.05± 7.10 ） ×10^-3μg/ml, respectively, with a significant difference between them （P 〈0.05）. It in the experimental group was （ 12.70 ± 2.15） ×10^-3μg/ml and （ 13.65 ± 7.82） ×10^-3μg/ml, respectively, without a significant difference （P 〉 0.05）. The hart rate （HR） before chemotherapy and after four cycles of chemotherapy in the control group, was 75.32 ±7.14 bpm and 89.60 ± 9.21 bpm, respectively, with a significant difference （P 〈0.05）. It in the experimental group was 78.60±6.29 bpm and 83.10±7.56 bpm, respectively, without a significant difference （P 〉 0. 05 ）. The left ventricular ejection fraction （LVEF） before chemotherapy and after four cycles of chemotherapy in the control group was （65.23± 7.82） % and （55.21 ± 7.23 ） %, respectively, with a significant difference between them （ P 〈 0.05 ）. It in the experimental group was （ 64.12 ± 6.25 ） % and （ 59.6 ± 4.72 ） %, respectively, without a significant difference （P 〉 0. 05 ）. The absolute neutrophil count before chemotherapy and after four cycles of chemotherapy in the control group was （3.95± 1.36 ） ×10^-9/L and （ 3.50 ± 1.52 ） ×10^-9/L, respectively, without a significant difference （ P 〉 0.05 ）. It in the experimental group, was （4.96± 1.41 ） ×10^-9/L and （3.10 ± 1.26） ×10^-9/L, respectively, with a significant difference （P 〈0.05）. The incidence of grade I - 1V bone marrow suppression in the experimental group was 21. 3%, 16.4%, 24. 6%, and 4. 9%, respectively. It in the control group was 16.4%, 11.5%, 9. 8%, and 5. 5%, respectively, with a significant difference （P 〈 0.05）. Conclusions Cardiac toxicity after anthracycline treatment in breast cancer patients may be significantly reduced by DEX, without increase of non-cardiac and and non- hematologic toxicity. DEX combined with anthracycline increases the risk of bone marrow suppression, therefore, peripheral blood picture should be monitored or routine bone marrow support may be needed.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2013年第2期135-139,共5页
Chinese Journal of Oncology
关键词
乳腺肿瘤
蒽环类
右丙亚胺
治疗结果
毒性
副作用
Breast neoplasms
Anthracyclines
Dexrazoxane
Treatment outcome
Toxicity
Side effects
作者简介
通信作者：张瑾，Email：davidz9132002@yahoo．com
