曲妥珠单抗相关心脏毒性1例并文献复习

1例45岁女性患者因确诊“左乳腺恶性肿瘤”，FISH检测HER-2阳性，在吡柔比星化疗6次后行紫杉醇＋曲妥珠单抗化疗，曲妥珠单抗起始周期为7d（4mg·kg-1），化疗2次后周期改为21d（6mg·kg-1），6个月后改为曲妥珠单抗单药21d方案化疗，18个月后患者出现胸闷、憋气症状，活动后明显，伴有双下肢水肿，心脏超声提示LVEF值33%。考虑该患者出现心功能不全与曲妥珠单抗的心脏毒性很可能相关。停用曲妥珠单抗化疗，予以去乙酰毛花甙强心、托拉塞米利尿、左卡尼汀营养心肌等治疗10d，患者症状完全消失，LVEF值恢复至45%，4个月后复查LVEF值恢复至51%。

Cardiac toxicity induced by trastuzumab in a patient with breast cancer and literature review

One case of 45-year-old female patient diagnosed as left breast cancer with positive FISH detection of HER-2 underwent chemotherapy with paclitaxel and trastuzumab after 6 times of chemotherapy with pirarubicin. The initial therapy period of trastuzumab was 7 days （4 mg·kg-1） and changed to 21 days （6 mg·kg-1） after 2 chemotherapies. Six months later, the chemotherapy was changed to trastuzumab with the cycle for 21 days. Eighteen months later, the patient developed chest tightness and breathlessness with lower extremity edema, which was obvious after activities. Cardiac ultrasound showed the LVEF value was 33%. Cardiac dysfunction induced by trastuzumab was considered and the chemotherapy of trastuzumab was stopped. Deacetylase lanatoside, torasemide diuretic and levocarnitine were given for improving heart function, diuresis and nutrition myocardium for 10 days. Then the symptom disappeared, LVEF value recovered to 45%. After 4 months, LVEF value recovered to 51%.