中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2013年
2期
135-139
,共5页
王培%张晟%张霄蓓%李文津%郝晓甍%张瑾
王培%張晟%張霄蓓%李文津%郝曉甍%張瑾
왕배%장성%장소배%리문진%학효맹%장근
乳腺肿瘤%蒽环类%右丙亚胺%治疗结果%毒性%副作用
乳腺腫瘤%蒽環類%右丙亞胺%治療結果%毒性%副作用
유선종류%은배류%우병아알%치료결과%독성%부작용
Breast neoplasms%Anthracyclines%Dexrazoxane%Treatment outcome%Toxicity%Side effects
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)×10-6 μg/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)×10-6 μg/ml和(105.29±7.21)×10-6 μg/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) ×10-3 μg/ml和(31.05±7.10)×10-3 μg/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(12.70±2.15)×10-3μg/ml和(13.22 ±7.82)×10-3 μg/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)×109/L和(3.50±1.52)×109/L,差异无统计学意义(P＞0.05);实验组化疗前后ANC计数分别为(4.96±1.41)×109/L和(3.10±1.26)×109/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.
目的 探討右丙亞胺(DEX)對乳腺癌患者接受含蒽環類藥物化療時的心髒保護作用.方法 選取122例乳腺癌術後患者,隨機分為實驗組和對照組.實驗組61例,在接受含蒽環類藥物化療方案的同時,採用DEX治療;對照組61例,患者僅採用含蒽環類藥物化療方案.所有患者化療4箇週期,分彆鑑測化療前後患者的心髒功能狀態和血液學變化,觀察化療的非心髒及血液學毒性反應.結果 對照組患者化療前後B型腦利鈉肽(BNP)分彆為(106.78±4.52)×10-6μg/ml和(187.19 ±8.71)×10-6 μg/ml,差異有統計學意義(P＜0.05);實驗組患者化療前後BNP分彆為(102.34 ±8.76)×10-6 μg/ml和(105.29±7.21)×10-6 μg/ml,差異無統計學意義(P＞0.05).對照組患者化療前後心肌肌鈣蛋白T(cTnT)分彆為(12.55±2.73) ×10-3 μg/ml和(31.05±7.10)×10-3 μg/ml,差異有統計學意義(P＜0.05);實驗組患者化療前後cTnT分彆為(12.70±2.15)×10-3μg/ml和(13.22 ±7.82)×10-3 μg/ml,差異無統計學意義(P＞0.05).對照組患者化療前後心率分彆為(75.32±7.14)次/min和(89.60±9.21)次/min,差異有統計學意義(P＜0.05);實驗組患者化療前後心率分彆為(78.60±6.29)次/min和(83.10±7.56)次/min,差異無統計學意義(P＞0.05);對照組患者化療前後左室射血分數(LVEF)分彆為(65.23±7.82)％和(55.21 ±7.23)％,差異有統計學意義(P＜0.05);實驗組化療前後LVEF分彆為(64.12±6.25)％和(59.36±4.72)％,差異無統計學意義(P＞0.05).對照組患者化療前後中性粒細胞(ANC)計數分彆為(3.95±1.36)×109/L和(3.50±1.52)×109/L,差異無統計學意義(P＞0.05);實驗組化療前後ANC計數分彆為(4.96±1.41)×109/L和(3.10±1.26)×109/L,差異有統計學意義(P＜0.05).兩組患者非心髒及血液學毒性反應的差異無統計學意義(P＞0.05).實驗組Ⅰ～Ⅳ度骨髓抑製髮生率分彆為21.3％、16.4％、24.6％和4.9％.對照組Ⅰ～Ⅳ度骨髓抑製髮生率分彆為16.4％、11.5％、9.8％和5.5％,差異有統計學意義(P＜0.05).結論 DEX在不增加乳腺癌患者非心髒及血液學毒性的前提下,可明顯降低蒽環類藥物化療患者的心髒毒性.DEX聯閤蒽環類藥物增加瞭乳腺癌患者骨髓抑製的髮生風險,在聯閤使用時應密切鑑測患者血象或給予常規骨髓支持.
목적 탐토우병아알(DEX)대유선암환자접수함은배류약물화료시적심장보호작용.방법 선취122례유선암술후환자,수궤분위실험조화대조조.실험조61례,재접수함은배류약물화료방안적동시,채용DEX치료;대조조61례,환자부채용함은배류약물화료방안.소유환자화료4개주기,분별감측화료전후환자적심장공능상태화혈액학변화,관찰화료적비심장급혈액학독성반응.결과 대조조환자화료전후B형뇌리납태(BNP)분별위(106.78±4.52)×10-6μg/ml화(187.19 ±8.71)×10-6 μg/ml,차이유통계학의의(P＜0.05);실험조환자화료전후BNP분별위(102.34 ±8.76)×10-6 μg/ml화(105.29±7.21)×10-6 μg/ml,차이무통계학의의(P＞0.05).대조조환자화료전후심기기개단백T(cTnT)분별위(12.55±2.73) ×10-3 μg/ml화(31.05±7.10)×10-3 μg/ml,차이유통계학의의(P＜0.05);실험조환자화료전후cTnT분별위(12.70±2.15)×10-3μg/ml화(13.22 ±7.82)×10-3 μg/ml,차이무통계학의의(P＞0.05).대조조환자화료전후심솔분별위(75.32±7.14)차/min화(89.60±9.21)차/min,차이유통계학의의(P＜0.05);실험조환자화료전후심솔분별위(78.60±6.29)차/min화(83.10±7.56)차/min,차이무통계학의의(P＞0.05);대조조환자화료전후좌실사혈분수(LVEF)분별위(65.23±7.82)％화(55.21 ±7.23)％,차이유통계학의의(P＜0.05);실험조화료전후LVEF분별위(64.12±6.25)％화(59.36±4.72)％,차이무통계학의의(P＞0.05).대조조환자화료전후중성립세포(ANC)계수분별위(3.95±1.36)×109/L화(3.50±1.52)×109/L,차이무통계학의의(P＞0.05);실험조화료전후ANC계수분별위(4.96±1.41)×109/L화(3.10±1.26)×109/L,차이유통계학의의(P＜0.05).량조환자비심장급혈액학독성반응적차이무통계학의의(P＞0.05).실험조Ⅰ～Ⅳ도골수억제발생솔분별위21.3％、16.4％、24.6％화4.9％.대조조Ⅰ～Ⅳ도골수억제발생솔분별위16.4％、11.5％、9.8％화5.5％,차이유통계학의의(P＜0.05).결론 DEX재불증가유선암환자비심장급혈액학독성적전제하,가명현강저은배류약물화료환자적심장독성.DEX연합은배류약물증가료유선암환자골수억제적발생풍험,재연합사용시응밀절감측환자혈상혹급여상규골수지지.
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) × 10-6 μg/ml and (187.19 ± 8.71) × 10-6 μg/ml,respectively,with a significant difference between them (P ＜ 0.05).It in the experimental group was (102.34 ± 8.76) × 10-6 μg/ml and (105.29 ± 7.21) × 10-6 μg/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) ×10-3 μg/ml and (31.05 ±7.10) × 10-3 μg/ml,respectively,with a significant difference between them (P ＜ 0.05).It in the experimental group was (12.70 ± 2.15) × 10-3 μg/ml and (13.65 ± 7.82) × 10-3 μg/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) × 109/L and (3.50 ± 1.52) × 109/L,respectively,without a significant difference (P ＞0.05).It in the experimental group,was (4.96 ± 1.41) × 109/L and (3.10 ± 1.26) × 109/L,respectively,with a significant difference (P ＜ 0.05).The incidence of grade Ⅰ-Ⅳ 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 nonhematologic 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.
