中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
29期
3461-3464
,共4页
心脉隆注射液%蒽环类药物%心脏毒性%药物预防
心脈隆註射液%蒽環類藥物%心髒毒性%藥物預防
심맥륭주사액%은배류약물%심장독성%약물예방
Xinmailong injection%Anthracyclines%Cardiac toxicity%Chemoprophylaxis
目的:探讨心脉隆注射液对蒽环类药物所致心脏毒性的预防效果。方法选取2013年4-12月就诊于河北省人民医院经病理组织学和细胞学确诊的恶性肿瘤患者60例,将患者按随机抽号法分为治疗组和对照组,每组30例。对照组给予单纯蒽环类药物化疗,治疗组在单纯化疗基础上联合应用心脉隆注射液,两组均以21 d为1个治疗周期,连续完成6个周期治疗。两组分别于治疗前及治疗3、6周期结束后进行超声心动图检查〔左心室舒张末期内径( LVIDD),左心室收缩末期内径( LVISD),舒张早期与晚期充盈速度比值( E/A),左心室射血分数( LVEF)〕、心电图检查〔非特异性ST-T段和T波改变、QRS 低电压及各种心律失常(各种期前收缩、心动过速、房室传导阻滞等)情况〕,检测血清肌钙蛋白I( cTnI)水平。结果对照组2例患者因肿瘤进展未完成6个周期的治疗,治疗组1例患者死亡,以上患者均剔除研究,最终对照组28例,治疗组29例。两组患者治疗前及治疗3、6周期后LVEF、E/A、LVIDD、LVISD比较,差异均有统计学意义( P<0.05)。组间比较显示,治疗前LVEF、E/A、LVIDD、LVISD比较,差异无统计学意义(P>0.05);治疗6周期后两组E/A、LVIDD、LVISD比较,差异有统计学意义(P<0.05)。组内比较显示,对照组治疗6周期后LVIDD、LVISD均高于治疗前(P<0.05)。对照组患者治疗前心电图异常0例;治疗3周期后心电图异常10例,异常率为35.7%;治疗6周期后心电图异常18例,异常率为64.3%。治疗组患者治疗前心电图异常0例;治疗3周期后心电图异常4例,异常率为13.8%;治疗6周期后心电图异常5例,异常率为17.2%。组间比较显示,治疗3周期后两组心电图异常率比较,差异无统计学意义(χ2=3.695,P=0.055);治疗6周期后心电图异常率比较,差异有统计学意义(χ2=13.099,P<0.001)。组内比较显示,对照组治疗前心电图异常率低于治疗3、6周期后(χ2=12.174、25.526,P<0.001),治疗3周期后低于治疗6周期后(χ2=4.571,P=0.033);治疗组治疗前心电图异常率低于治疗3、6周期后(χ2=4.296、5.472,P=0.035、0.019)。两组患者治疗前及治疗3、6周期后血清cTnI水平比较,差异均有统计学意义( P<0.05)。组间比较显示,治疗前两组血清cTnI水平比较,差异无统计学意义(P>0.05);治疗3、6周期后两组血清cTnI水平比较,差异均有统计学意义(P<0.05)。组内比较显示,两组治疗3、6周期后血清cTnI水平均高于治疗前( P<0.05)。结论心脉隆注射液能够减轻蒽环类药物的心脏毒性,增强患者对蒽环类药物化疗的耐受性,对蒽环类化疗药物所致心脏毒性有一定的预防效果,为临床进一步研究提供了参考依据。
目的:探討心脈隆註射液對蒽環類藥物所緻心髒毒性的預防效果。方法選取2013年4-12月就診于河北省人民醫院經病理組織學和細胞學確診的噁性腫瘤患者60例,將患者按隨機抽號法分為治療組和對照組,每組30例。對照組給予單純蒽環類藥物化療,治療組在單純化療基礎上聯閤應用心脈隆註射液,兩組均以21 d為1箇治療週期,連續完成6箇週期治療。兩組分彆于治療前及治療3、6週期結束後進行超聲心動圖檢查〔左心室舒張末期內徑( LVIDD),左心室收縮末期內徑( LVISD),舒張早期與晚期充盈速度比值( E/A),左心室射血分數( LVEF)〕、心電圖檢查〔非特異性ST-T段和T波改變、QRS 低電壓及各種心律失常(各種期前收縮、心動過速、房室傳導阻滯等)情況〕,檢測血清肌鈣蛋白I( cTnI)水平。結果對照組2例患者因腫瘤進展未完成6箇週期的治療,治療組1例患者死亡,以上患者均剔除研究,最終對照組28例,治療組29例。兩組患者治療前及治療3、6週期後LVEF、E/A、LVIDD、LVISD比較,差異均有統計學意義( P<0.05)。組間比較顯示,治療前LVEF、E/A、LVIDD、LVISD比較,差異無統計學意義(P>0.05);治療6週期後兩組E/A、LVIDD、LVISD比較,差異有統計學意義(P<0.05)。組內比較顯示,對照組治療6週期後LVIDD、LVISD均高于治療前(P<0.05)。對照組患者治療前心電圖異常0例;治療3週期後心電圖異常10例,異常率為35.7%;治療6週期後心電圖異常18例,異常率為64.3%。治療組患者治療前心電圖異常0例;治療3週期後心電圖異常4例,異常率為13.8%;治療6週期後心電圖異常5例,異常率為17.2%。組間比較顯示,治療3週期後兩組心電圖異常率比較,差異無統計學意義(χ2=3.695,P=0.055);治療6週期後心電圖異常率比較,差異有統計學意義(χ2=13.099,P<0.001)。組內比較顯示,對照組治療前心電圖異常率低于治療3、6週期後(χ2=12.174、25.526,P<0.001),治療3週期後低于治療6週期後(χ2=4.571,P=0.033);治療組治療前心電圖異常率低于治療3、6週期後(χ2=4.296、5.472,P=0.035、0.019)。兩組患者治療前及治療3、6週期後血清cTnI水平比較,差異均有統計學意義( P<0.05)。組間比較顯示,治療前兩組血清cTnI水平比較,差異無統計學意義(P>0.05);治療3、6週期後兩組血清cTnI水平比較,差異均有統計學意義(P<0.05)。組內比較顯示,兩組治療3、6週期後血清cTnI水平均高于治療前( P<0.05)。結論心脈隆註射液能夠減輕蒽環類藥物的心髒毒性,增彊患者對蒽環類藥物化療的耐受性,對蒽環類化療藥物所緻心髒毒性有一定的預防效果,為臨床進一步研究提供瞭參攷依據。
목적:탐토심맥륭주사액대은배류약물소치심장독성적예방효과。방법선취2013년4-12월취진우하북성인민의원경병리조직학화세포학학진적악성종류환자60례,장환자안수궤추호법분위치료조화대조조,매조30례。대조조급여단순은배류약물화료,치료조재단순화료기출상연합응용심맥륭주사액,량조균이21 d위1개치료주기,련속완성6개주기치료。량조분별우치료전급치료3、6주기결속후진행초성심동도검사〔좌심실서장말기내경( LVIDD),좌심실수축말기내경( LVISD),서장조기여만기충영속도비치( E/A),좌심실사혈분수( LVEF)〕、심전도검사〔비특이성ST-T단화T파개변、QRS 저전압급각충심률실상(각충기전수축、심동과속、방실전도조체등)정황〕,검측혈청기개단백I( cTnI)수평。결과대조조2례환자인종류진전미완성6개주기적치료,치료조1례환자사망,이상환자균척제연구,최종대조조28례,치료조29례。량조환자치료전급치료3、6주기후LVEF、E/A、LVIDD、LVISD비교,차이균유통계학의의( P<0.05)。조간비교현시,치료전LVEF、E/A、LVIDD、LVISD비교,차이무통계학의의(P>0.05);치료6주기후량조E/A、LVIDD、LVISD비교,차이유통계학의의(P<0.05)。조내비교현시,대조조치료6주기후LVIDD、LVISD균고우치료전(P<0.05)。대조조환자치료전심전도이상0례;치료3주기후심전도이상10례,이상솔위35.7%;치료6주기후심전도이상18례,이상솔위64.3%。치료조환자치료전심전도이상0례;치료3주기후심전도이상4례,이상솔위13.8%;치료6주기후심전도이상5례,이상솔위17.2%。조간비교현시,치료3주기후량조심전도이상솔비교,차이무통계학의의(χ2=3.695,P=0.055);치료6주기후심전도이상솔비교,차이유통계학의의(χ2=13.099,P<0.001)。조내비교현시,대조조치료전심전도이상솔저우치료3、6주기후(χ2=12.174、25.526,P<0.001),치료3주기후저우치료6주기후(χ2=4.571,P=0.033);치료조치료전심전도이상솔저우치료3、6주기후(χ2=4.296、5.472,P=0.035、0.019)。량조환자치료전급치료3、6주기후혈청cTnI수평비교,차이균유통계학의의( P<0.05)。조간비교현시,치료전량조혈청cTnI수평비교,차이무통계학의의(P>0.05);치료3、6주기후량조혈청cTnI수평비교,차이균유통계학의의(P<0.05)。조내비교현시,량조치료3、6주기후혈청cTnI수평균고우치료전( P<0.05)。결론심맥륭주사액능구감경은배류약물적심장독성,증강환자대은배류약물화료적내수성,대은배류화료약물소치심장독성유일정적예방효과,위림상진일보연구제공료삼고의거。
Objective To explore the preventive effects of Xinmailong injection on anthracyclines induced cardiac tox-icity. Methods Sixty malignant tumor patients in People's Hospital of Hebei Province from April to December 2013 were divided randomly into groups therapy,control,30 in each. Control group were given only anthracycline chemotherapy,therapy group combined with Xinmailong injection,21 d as a therapeutic cycle,altogether 6 cycles. Underwent echocardiogranphy left ventric-ular internal diameter at end-diastole( LVIDD),left ventricular internal end-systolic dimension( LVISD),early and late diastolic filling velocity ratio( E/A),left ventricular ejection fraction( LVEF),ECG〔non-specific ST-T segment and T wave changes,QRS low voltage and vatious arrhythmias( proiosystole,tachycardia,atrioventricular block,etc. )〕and deter-mined serum cardiac troponin I( cTnI)level before treatment,after 3,6 treatment cycles. Results 2 patients in control group,1 in therapy group died due to tumor progression. There were 28 cases in control group,29 in therapy group after exclu-ding the above cases. There was significant difference in LVEF,E/A,LVIDD,LVISD between 2 groups before therapy,after 3,6 therapy cycles(P<0. 05). In group comparison,there was no difference in LVEF,E/A,LVIDD,LIVSD before treat-ment(P>0. 05);there was in E/A,LVIDD,LVISD between 2 groups after a cycles(P<0. 05). In intra-group compari-son,LVIDD,LVISD were higher after 6 cycles than before treatment in control group(P<0. 05). In control group,no pa-tients had ECG abnormalities before treatment,10 had after 3 treatment cycles(35. 7%),18 had after 6 cycles(64. 3%), and in therapy group,0,4(13. 8%),5(17. 2%),respectively. There was no significant difference in ECG abnormality between 2 groups after 3 cycles(χ2 =3. 695,P=0. 055);there was after 6 cycles(χ2 =13. 099,P=0. 000). In control group,ECG abnormality was lower before treatment than after 3,6 treatment cycles(χ2 =12. 174,25. 526,P =0. 000, 0. 000),lower after 3 cycles than after 6 cycles(χ2 =4. 571,P=0. 033);in therapy group,ECG abnormality was lower be-fore treatment than after 3,6 cycles(χ2 =4. 29,5. 472,P=0. 035,0. 019). There was difference in serum cTnI between 2 groups before treatment and after 3,6 cycles(P <0. 05). In group comparison,there was no difference in cTnI between 2 groups before treatment(P>0. 05);there was after 3,6 treatment cycles(P<0. 05). In intra-group comparison,cTnI was higher after 3,6 cycles than before treatment(P<0. 05). Conclusion Xinmailong injection can reduce anthracycline induced cardiac toxicity,enhance patients' tolerance to anthracycline chemotherapy. It is of some preventive effects on anthracycline chemotherapy-induced cardiotoxicity.