CAJ | 학술논문

目的探讨在乳腺癌辅助化疗中,应用小剂量卡维地洛联合坎地沙坦预防蒽环类药物急、慢性心脏毒性的临床疗效和不良反应.方法 40例乳腺癌辅助化疗患者,随机分为研究组和对照组,每组20例,两组患者均无卡维地洛及坎地沙坦使用禁忌证.在应用氟尿嘧啶+表柔比星+环磷酰胺方案的基础上,研究组加用小剂量卡维地洛联合坎地沙坦.于化疗2、4、6个周期后,分别观察两组患者超声心动图、心电图ST段及T波、QRS波群电压、心律失常、肌钙蛋白等变化以及非血液性毒性.结果随着化疗周期的延长,研究组和对照组患者的左室射血分数(LVEF)均下降,研究组患者的左心室舒张末内径(LVEDD)和左心室收缩末内径(LVESD)无明显改变,而对照组患者的LVEDD和LVESD逐渐增加.在化疗4、6个周期后,对照组患者的LVEF分别为(57.00±5.13)％和(45.95±3.68)％,明显低于研究组[(67.00±5.13)％和(57.50±2.57)％,均P＜0.05].化疗6个周期后,对照组患者的LVEDD和LVESD分别为(50.00±10.48) mm和(35.01±2.99) mm,明显高于化疗前水平(均P ＜0.05),也明显高于研究组(均P＜0.001).化疗6个周期后,对照组患者ST段及T波异常的发生率为80.0％,明显高于化疗4个周期后(25.0％,P=0.001)和化疗2个周期后(10.0％,P ＜0.001);对照组患者QRS波群电压下降的发生率为55.0％,明显高于研究组(20.0％,P＜0.05);对照组患者心律失常的发生率为45.0％,明显高于研究组(10.0％,P=0.010);对照组患者肌钙蛋白异常的发生率为45.0％,明显高于研究组(10.0％,P＜0.05).结论小剂量卡维地洛联合坎地沙坦能够预防蒽环类药物的心脏毒性,且毒副作用可耐受,有望为临床防治蒽环类药物的心脏毒性提供一种新的治疗方法.
목적 탐토재유선암보조화료중,응용소제량잡유지락연합감지사탄예방은배류약물급、만성심장독성적림상료효화불량반응.방법 40례유선암보조화료환자,수궤분위연구조화대조조,매조20례,량조환자균무잡유지락급감지사탄사용금기증.재응용불뇨밀정+표유비성+배린선알방안적기출상,연구조가용소제량잡유지락연합감지사탄.우화료2、4、6개주기후,분별관찰량조환자초성심동도、심전도ST단급T파、QRS파군전압、심률실상、기개단백등변화이급비혈액성독성.결과 수착화료주기적연장,연구조화대조조환자적좌실사혈분수(LVEF)균하강,연구조환자적좌심실서장말내경(LVEDD)화좌심실수축말내경(LVESD)무명현개변,이대조조환자적LVEDD화LVESD축점증가.재화료4、6개주기후,대조조환자적LVEF분별위(57.00±5.13)％화(45.95±3.68)％,명현저우연구조[(67.00±5.13)％화(57.50±2.57)％,균P＜0.05].화료6개주기후,대조조환자적LVEDD화LVESD분별위(50.00±10.48) mm화(35.01±2.99) mm,명현고우화료전수평(균P ＜0.05),야명현고우연구조(균P＜0.001).화료6개주기후,대조조환자ST단급T파이상적발생솔위80.0％,명현고우화료4개주기후(25.0％,P=0.001)화화료2개주기후(10.0％,P ＜0.001);대조조환자QRS파군전압하강적발생솔위55.0％,명현고우연구조(20.0％,P＜0.05);대조조환자심률실상적발생솔위45.0％,명현고우연구조(10.0％,P=0.010);대조조환자기개단백이상적발생솔위45.0％,명현고우연구조(10.0％,P＜0.05).결론 소제량잡유지락연합감지사탄능구예방은배류약물적심장독성,차독부작용가내수,유망위림상방치은배류약물적심장독성제공일충신적치료방법.
Objective To investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.Methods Forty patients were randomly divided into two groups:the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan (20 cases) and control group with chemotherapy alone (20 cases).The same chemotherapy was given to the two groups.All the 40 patients had no contraindication for carvedilol and candesartan.Patients of the experimental group received low-dose carvedilol from 2.5 mg orally twice a day at first cycle to 5 mg twice a day gradually if no side reactions,and candesartan 2.5 mg orally once a day.Electrocardiogram,ultrasonic cardiogram,arrhythmia,troponin and non-hematologic toxicity were recorded and compared after the second,forth and sixth cycle of chemotherapy.Each cycle included 21 days.Results LVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group.LVEDD and LVESD showed no significant changes in the experimental group,but gradually increased in the control group.After four and six cycles of chemotherapy,LVEF were (57.00 ± 5.13) ％ and (45.95 ± 3.68) ％,respectively,in the control group,significantly lower than that of (67.00 ± 5.13) ％ and (57.50 ± 2.57) ％,respectively,in the experimental group (P ＜ 0.05).After six cycles of chemotherapy,LVEDD and LVESD were (50.00 ± 10.48) mm and (35.01 ± 2.99) mm,respectively,in the control group,significantly higher than those before chemotherapy (P ＜ 0.05) and experimental group (P ＜ 0.001).The rate of ST segment and T wave abnormalities was 80.0％ in the control group after six cycles of chemotherapy,significantly higher than that of 25.0％ after four cycles of chemotherapy (P =0.001) and 10.0％ after two cycles of chemotherapy (P ＜ 0.001).The reduction of QRS voltage,arrhythmia and abnormal troponin were 55.0％,45.0％ and 45.0％,respectively,in the control group,significantly higher than those in the experimental group (20.0％,P ＜0.05),(10.0％,P =0.010) and (10.0％,P ＜ 0.05),respectively.The rate of abnormal expression of troponin was 45.0％ in the control group,significantly higher than the 10.0％ in the experimental group (P ＜ 0.05).Conclusions The use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs,and with tolerable toxicities.This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.