CAJ | 학술논문

目的：小剂量联合使用卡维地洛及坎地沙坦对预防乳腺癌辅助化疗中的蒽环类药物产生的心脏毒性的临床应用效果及毒副作用。方法选择56例接受乳腺癌化疗的患者，随机分为实验组（28例）及对照组（28例）。对照组采用氟尿嘧啶、表柔比星、环磷酰胺的化疗方案，实验组在此基础上加用小剂量卡维地洛、卡地沙坦。化疗期间分别于化疗后6周、12周，观察患者超声心动图、心电图、肌钙蛋白变化及其副作用。结果治疗一段时间后，实验组患者超声心动图观测LVEDD（左室舒张末期内径）及LVESD（左室收缩末期内径）较治疗前无明显变化（P＞0．05）；治疗后对照组LVEDD及LVESD与实验组相比，均明显增大（P＜0．05），实验组患者LVEF（左室射血分数）与治疗前相比下降，与对照组相比明显较高（P＜0．05）；心电图检测治疗前实验组与对照组均未出现心电异常，化疗后，实验组QRS波、ST段及T波异常者较对照组少（P＜0．05）。实验组心律失常及肌钙蛋白异常者明显少于对照组（P＜0．05）。结论小剂量联合使用卡维地洛及坎地沙坦预防乳腺癌辅助化疗中蒽环类药物产生的心脏毒性，效果明显、毒副作用较低，患者易于接受，值得在临床中推广应用。
목적：소제량연합사용잡유지락급감지사탄대예방유선암보조화료중적은배류약물산생적심장독성적림상응용효과급독부작용。방법선택56례접수유선암화료적환자，수궤분위실험조（28례）급대조조（28례）。대조조채용불뇨밀정、표유비성、배린선알적화료방안，실험조재차기출상가용소제량잡유지락、잡지사탄。화료기간분별우화료후6주、12주，관찰환자초성심동도、심전도、기개단백변화급기부작용。결과치료일단시간후，실험조환자초성심동도관측LVEDD（좌실서장말기내경）급LVESD（좌실수축말기내경）교치료전무명현변화（P＞0．05）；치료후대조조LVEDD급LVESD여실험조상비，균명현증대（P＜0．05），실험조환자LVEF（좌실사혈분수）여치료전상비하강，여대조조상비명현교고（P＜0．05）；심전도검측치료전실험조여대조조균미출현심전이상，화료후，실험조QRS파、ST단급T파이상자교대조조소（P＜0．05）。실험조심률실상급기개단백이상자명현소우대조조（P＜0．05）。결론소제량연합사용잡유지락급감지사탄예방유선암보조화료중은배류약물산생적심장독성，효과명현、독부작용교저，환자역우접수，치득재림상중추엄응용。
Objective To study the preventive value of small dose of carvedilol combined with candesartan on anthracy-cline cardiotoxicity in breast cancer treated with adjuvant chemotherapy and side effects.Methods 56 cases of breast cancer pa-tients underwent chemotherapy were randomly divided into the experimental group(28 cases) and the control group(29 cases). The control group received fluorouracil, epirubicin, cyclophosphamide chemotherapy scheme, the experimental group received small dose of carvedilol and candesartan on the base of the control group.During chemotherapy,6 weeks and 12 weeks after chem-otherapy,ultrasound,ECG,cardiac troponin changes and side effects were observed.Results After a period of treatment,echocar-diography of left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) in the experi-mental group had no significant change than before the treatment(P>0.05);compared with the control group after treatment, LVEDD and LVESD in the experimental group significantly increased(P<0.05),left ventricular ejection fraction(LVEF) in the experimental group decreased significantly than before the treatment,compared with the control group,the experimental group sig-nificantly increased(P<0.05);There were no ECG abnormalities in the 2 groups before the treatment.After treatment,QRS wave and ST segment and T wave abnormalities in the experimental group were less than those of the control group(P<0.05).Ar-rhythmia and cardiac troponin abnormality in the experimental group were significantly lower than those of the control group( P<0.05).Conclusion Small dose of carvedilol combined with candesartan for anthracycline cardiotoxicity in breast cancer treated with adjuvant chemotherapy is effective with lower toxicity,and it is easily accepted by patients,it is worthy of clinical applica-tion.