右丙亚胺联合环磷腺苷降低蒽环类药物心脏毒性的临床研究

目的：探讨右丙亚胺联合环磷腺苷治疗对血液系统肿瘤患者蒽环类药物多疗程化疗所致心脏不良反应的影响。方法：80例血液系统肿瘤患者随机分为对照组、环磷腺苷组、右丙亚胺组和联合用药组，每组20例。对照组仅予蒽环类药物单纯化疗；环磷腺苷组每次化疗开始予环磷腺苷注射液20ml·d-1，疗程1周；右丙亚胺组化疗前30min予右丙亚胺（与多柔比星剂量比为10：1）快速静滴；联合用药组化疗前30min予右丙亚胺（与多柔比星剂量比为10：1）快速静滴，同时在每次化疗开始予环磷腺苷20ml·d-1疗程1周。4组患者均按要求完成4个化疗周期，观察化疗前后4组患者的心电图改变及超声心动图（左室射血分数LVEF）、B型脑钠肽（BNP）水平变化。结果：右丙亚胺组、联合用药组心电图异常比例明显低于对照组和环磷腺苷组（P〈0．0083）；4组治疗前后LVEF与BNP水平差值比较，各给药组均明显低于对照组，且联合用药组明显低于环磷腺苷组和右丙亚胺组（P〈0．05）。结论：血液系统肿瘤患者接受蒽环类药物多疗程化疗同时配伍使用环磷腺苷及右丙亚胺，可降低蒽环类药物所致心脏毒性，且两药联用疗效最佳，而右丙亚胺单用对心肌细胞保护作用好于环磷腺苷单用。

Clinical Study on Anthracycline Cardiotoxicity Reduction by Dexrazoxane Combined with cAMP

Objective： To compare the effects of a single dose of dexrazoxane or cAMP and their combined use on anthracycline cardiotoxicity in the multiple treatment course of patients with hematological malignancies to explore better alternatives for reducing an- thracycline cardiotoxicity. Methods： In the study, 80 patients were randomly divided into 4 groups with 20 cases each. Group A （ cAMP group） received cAMP 20 ml ·d-1 for a week before every, treatment course. Group B was treated with dexrazoxane and adriamycin at a dosage ratio of 10：1 via a fast intravenous drip 30 rain before the application of anthraeycline chemotherapy, and the 20 ml cAMP was given once a week before the chemotherapy session. Group C only received dexrazoxane. Anthracyclines was administered 30 min before each chemotherapy session. Groups A, B, and C were the experimental groups, and group D was designed as the blank control group. All groups received four complete cycles of chemoiherapy. The ECG changes, echocardiography （ left ventricular ejection fraction, LVEF） and B-type brain natriuretic peptide （BNP） values of all the groups were observed before and after the chemotherapy. Results： As for the ECG changes, group B and C had lower incidence rate of abnormal ECG than group A and D（P 〈 0. 008 3 ）. Significantly decreased LVEF and increased BNP values were observed in group A, B and C compared with those in the cuntrol group （P 〈0.05）, and group B showed the most significant effect. Conclusion： All of the studied treatments can effectively reduce anthraeycline chemotherapy-induced cardiotoxicity in cancer patients, and the combination of cAMP and dexrazoxane exhibits the best effect. Dexrazoxane has better protective effect on myocardial cells than cAMP.