急性肿瘤患者右丙亚胺单药与联合华蟾素注射液治疗对阿霉素所致相关性心脏毒性的影响

目的：探讨恶性肿瘤患者右丙亚胺单药与联合华蟾素注射液治疗对阿霉素所致相关性心脏毒性的影响，并对比其疗效。方法选取恶性肿瘤患者166例为研究对象，随机分为单药组（右丙亚胺单药，61例）、联合用药组（联合应用右丙亚胺与华蟾素注射液，75例）与对照组（不予用药处理，30例）。3组患者均采用含蒽环类药物阿霉素的化疗方案。对照组化疗前不予用药处理；单药组化疗前30 min给予注射用右丙亚胺，按与阿霉素剂量比20∶1确定右丙亚胺剂量；联合用药组在化疗前同时给予右丙亚胺与华蟾素注射液15 ml，右丙亚胺用法用量同单药组。结果经4个化疗周期，（1）心脏毒性发生率方面：对照组53．3％，显著高于单药组（29．51％）、联合用药组（8．0％），P＜0．05；单药组显著高于联合用药组，P＜0．05。（2）心电图方面：3组病例在化疗开始前心电图均无异常改变。化疗过程中右丙亚胺单药组心电图异常者9例（14．75％）、联合用药组7例（9．33％），均显著低于对照组22例（73．3％）；联合用药组的心电图异常比例显著低于单药组，P＜0．05。（3）CK、CK-MB、TnI方面：单药组与对照组化疗后较本组化疗前显著上升（P＜0．05）；联合用药组化疗后CK、TnI较本组化疗前显著上升（P＜0．05），CK-MB与化疗前比较差异不显著，P＞0．05。化疗前3组差异不显著（P＞0．05）。化疗后单药组、联合用药组显著低于对照组，P＜0．05；联合用药组显著低于单药组，P＜0．05。（4）超声心动图参数LVIDD、LVISD、A／E、LVEF、FS方面：单药组与对照组化疗前、后均有显著差异（P＜0．05），但联合用药组化疗后较本组治疗前无显著差异（P＞0．05）。化疗前3患者各超声心动图参数均无显著差异（P＞0．05），化疗后3组间两两比较均有明显差异（P＜0．05）。结论右丙亚胺与华蟾素注射液对阿霉素所致心脏毒性具有一定的保护作用，联合用药可明显降低心脏毒性的发生率以及毒性程度，维持正常的心电图、心肌酶以及心功能变化，从而增强恶性肿瘤患者对化疗药物毒副作用的耐受能力、提高肿瘤患者的治疗效果。

Influences of Dexrazoxane Monotherapy Combined with Huachansu Injection on Adriamycin Induced Cardiotoxicity in Malignant Tumor Patients

Objective To study the effect of dexrazoxane single medicine and Huachansu injection on adriamycin in -duced cardiotoxicity in malignant tumor patients , and compare the efficacy .Methods 166 patients with malignant tumor were randomly divided into single drug group(dexrazoxane single medicine,31 cases),combination group(dexrazoxane and Huachansu injection,75 cases) and the control group(no drug treatment,30 cases),the 3 groups all received chemotherapy regimens with anthracycline-based drugs adriamycin .The control group was not treated with medication treatment before chemotherapy .Single drug group 30 min before chemotherapy was given dexrazoxane injection ,dexrazoxane dose compared with adriamycin dose was 20∶1,combination group before chemotherapy was give dexrazoxane and Huachansu injection 15 ml,dexrazoxane dose usage was the same as single drug group.Results After 4 cycles of chemotherapy,(1) cardiac toxicity ratio was 53.3% in the control group,which was significantly higher than that of single drug group (29.51%)and combination group(8.0%),P<0.05,cardiac toxicity ratio of single drug group was significantly higher than that of combination group ,P<0.05.(2)electrocardiogram of the 3 groups had no abnormal changes before the chemotherapy ,during chemotherapy process dexrazoxane single medicine group had 9 abnormal cases(14.75%) of electrocardiogram,combination group had 7 cases(9.33%),which was significantly lower than that of the control group,22 cases(73.3%).Electrocardiogram abnormal ratio of combination group was significantly lower than that of single medicine group,P<0.05.(3)CK,CK-MB,TnI of single medicine group and the control group after chemotherapy signifi -cantly increased(P<0.05);CK,CK-MB,TnI of combination group after chemotherapy significantly increased (P<0.05),CK-M B had no significant difference compared with before treatment ,P>0.05,the 3 groups before chemotherapy had no significant difference(P>0.05),after chemotherapy,single,medicine group and the combination group was significantly lower than the con-trol group,P<0.05,the combination group was significantly lower than that of single drug group ,P<0.05).(4) echocardio-graphy parameters LVIDD ,LVISD,A/E,LVEF,FS of single medicine group and the control group before and after chemotherapy had significant difference,P<0.05,the combination group after chemotherapy before treatment had no significant difference (P>0.05).The 3 groups before chemotherapy in echocardiography parameters had no significant difference (P>0.05),after chemo-therapy the 3 groups were significantly different (P<0.05).Conclusion Dexrazoxane and Huachansu injection for cardiac toxic-ity caused by adriamycin has certain protective effect ,the combination group can obviously reduce the incidence of cardiac toxicity and toxic level ,maintain normal electrocardiogram ,myocardial enzymes and the change of cardiac function ,increase tolerance of patients with malignant tumor to side effects of chemotherapy drug ,improve the efficacy of the treatment of patients with tumor .