血清cTnI联合BNP检测在乳腺癌化疗相关心脏毒性早期预测中的应用价值

目的:探究血清高敏心肌肌钙蛋白（cTnI）联合脑利钠肽（BNP）检测在乳腺癌化疗相关心脏毒性早期预测中的应用价值。方法:选择2015年12月至2016年12月本院收治的乳腺癌患者125例，所有患者均采用DA方案进行化疗，化疗前1天，每次化疗周期结束后第2天清晨采集静脉血液，收集血清，化学发光法检测血清cTnI、BNP水平，多普勒超声诊断仪对患者进行彩色多普勒超声检查，记录左室射血分数（LVEF），对所有患者进行随访，记录化疗过程中心脏毒性事件发生情况。结果:125例乳腺癌患者中有20例（16.00%）患者发生心脏毒性事件，心脏毒性患者中LVEF平均降低（15.38±1.23）%，8例患者出现明显的胸闷症状，心脏毒性与患者年龄、病理类型、淋巴结转移、绝经状态无关；无毒性组与心脏毒性组化疗前血清cTnI、BNP水平比较，差异无统计学意义（P＞0.05）。化疗后无毒性组与心脏毒性组患者血清cTnI、BNP水平均随着化疗周期的延长呈进行性升高，且同一周期下心脏毒性组血清cTnI、BNP水平显著高于无毒性组（P＜0.05）；ROC曲线图分析可知，6次化疗完成后血清cTnI、BNP水平诊断乳腺癌化疗相关心脏毒性的曲线下面积分别为0.943、0.887，诊断分界点分别为6.559 1×10-2 ng/mL、5×10-2 ng/mL，敏感性分别为90.00%、90.00%，特异性分别为84.76%、92.40%；血清cTnI、BNP联合检测对乳腺癌化疗相关心脏毒性诊断的曲线下面积为0.994，敏感性为94.60%，特异性为95.72%。结论:血清cTnI、BNP在乳腺癌化疗相关心脏毒性早期诊断中具有一定价值，且二者联合对乳腺癌化疗相关心脏毒性具有更高价值。

Application value of serum cTnI combined with BNP detection in early prediction of chemotherapy-related cardiotoxicity in breast cancer

Objective:To explore the value of serum high-sensitivity cardiac troponin(cTnI)combined with brain natriuretic peptide(BNP)in early prediction of chemotherapy-related cardiotoxicity in breast cancer.Methods:125 patients with breast cancer admitted to our hospital from December 2015 to December 2016 were selected.All patients were treated with DA regimen for chemotherapy,and the venous blood was collected at one day before chemotherapy and the morning of the second day after the end of each chemotherapy cycle.Serum was collected.Levels of serum cTnI and BNP were detected by electrochemiluminescence.The color Doppler ultrasonography was performed by Doppler ultrasonic diagnosis apparatus.Left ventricular ejection fraction(LVEF)was recorded.All patients were followed up to record the occurrence of cardiac toxicity events during chemotherapy.Results:Among 125 breast cancer patients,20(16.00%)had cardiotoxic events.In patients with cardiotoxicity,the average decrease of LVEF was(15.38±1.23)%.8 patients had obvious chest tightness.Cardiac toxicity was not related to age,pathological type,lymph node metastasis and menopausal status.There was no significant difference in serum cTnI and BNP levels between non-toxic group and cardiotoxic group before chemotherapy(P>0.05).After chemotherapy,the levels of serum cTnI and BNP in non-toxic group and cardiotoxic group increased progressively with the prolongation of chemotherapy cycle,and the levels of serum cTnI and BNP in cardiotoxic group were significantly higher than those in non-toxic group at the same cycle(P<0.05).The ROC curve analysis showed that,after 6 chemotherapies,the areas under the curve of serum cTnI and BNP levels for the diagnosis of chemotherapy-related cardiac toxicity in breast cancer were 0.943 and 0.887,respectively.The diagnostic thresholds were 6.5591×10^-2 ng/mL and 5×10^-2 ng/mL,respectively,the sensitivities were 90.00% and 90.00% respectively,and the specificities were 84.76% and 92.40% respectively.The area under the curve of combined detection of serum cTnI and BNP for the diagnosis of chemotherapy-related cardiotoxicity in breast cancer was 0.994.The sensitivity was 94.60%,and the specificity was 95.72%.Conclusion:Serum cTnI and BNP have certain value in early diagnosis of chemotherapy-related cardiotoxicity of breast cancer,and their combination has higher value for chemotherapy-related cardiotoxicity of breast cancer.