乳腺癌患者术后化疗所致早期心脏毒性监测指标的研究

目的：观察乳腺癌术后辅助化疗患者的早期心脏毒性监测指标（左室射血分数、心肌做功指数、心电图以及心肌钙蛋白）的变化，评价其敏感性及临床意义。方法：选取42例乳腺癌患者，随机分为两组：干预组21例，患者接受TAC（多西紫杉醇＋吡喃阿霉素＋环磷酰胺）方案加右丙亚胺（右丙亚胺对吡喃阿霉素比值为10：1）；化疗组21例，常规接受TAC方案加安慰剂治疗。采用重复测量设计资料的方差分析化疗前、化疗后每周期以及化疗结束后3个月的心脏毒性指标变化情况。结果：两组患者不同周期左室射血分数（LVEF）变化无统计学意义（P〉0.05）；心肌做功（Tel）指数随着化疗周期的增加其测量结果存在统计学差异（P〈0.05），且干预组患者Tel指数明显低于化疗组（P〈0.05）；两组患者心电图检查主要表现为一过性改变，均未出现明显特异性改变；在未达到吡喃阿霉素最大累积量前，血清中心肌钙蛋白（cTnI）与体内吡喃阿霉素累积量呈现零相关性（P〉0.05）。结论：蒽环类药物从第一次应用时对心脏就产生了明显的毒性，使用右丙亚胺对蒽环类药物所致心脏毒性有一定的防护作用。对两组患者心脏彩超、LVEF、心电图、cTnI等检查研究发现，上述指标对评价蒽环类药物所造成的亚临床左室结构与功能异常方面的敏感性与特异性较差，在临床上并不能及早有效评估化疗后患者早期心脏毒性，而Tel指数较之传统心脏超声、心电图、cTnI等能够更早、更敏感地评价蒽环类化疗药物对化疗患者心脏早期毒性。

The research of indexes about early cardiac toxicity induced by postoperative chemotherapy of mammary cancer

Objective：To observe the changes of early cardiac toxic indexes of postoperative chenaotherapy in mammary cancer, such as left ventricular ejection fraction （LVEF） , Tel index, eleetrocardiogram （ECG） and cardiac troponin. Methods：To choose 42 mammary cancer patients,divided into two groups randolnly, in intervention group, 22 patients were given TAC（taxotere ＋tetrahydropyranyl adriamycin ＋ cyclophosphanaide）and Dexrazoxane（the tetrahydropyranyl adrianlycin to dexrazoxane ratio 20：1）. Chenaotherapy group,21 patients were given TAC arid placebo. Analyzed cardiac toxic indexes before and after chemotherapy and 3 naonths ago. Results：The changes of LVEF were not statisticly significant in different periods between the two groups（P 〉 0.05）. For Tei index,there was statistic difference according to prolonging the chenaotherapy period （P 〈 0.05） , and Tel index of intervention group was lower than that of chenaotherapy group obviously （P 〈 0.05）. The ECG appeard single transient changes, arid had no obvious specific change. Before tetrahydropyranyl adriamycin closed the peak dose,there was no correlation between the dose of cTnI in blood serum and the dose of tetrahydropyranyl adrianlycin （ P 〉 0. 05）. Concluslon ： The obvious cardiac toxicity was observed when anthracycline compounds were first administrated,however the toxicity was decreased by dexrazoxane. Analyzed the results of eolour sonography,LVEF,ECg and cTni,we found that these indexes had weak sensitivity arid specificity which were induced by anthracycline compounds to evaluate sub - clinical left ventricular structure and malfunction, so they could not evaluate the early cardiac, toxooity to patients recepted chemotherapy. However Tel index was earlier arid naore sensitive to evaluate the early cardiac toxocity induced by anthracycline compounds than traditional cardiac ultrasound,ECG and cTnI.