右丙亚胺在老年乳腺癌辅助化疗中对心脏的保护作用

目的：观察右丙亚胺（dexrazoxane，DZR）对老年乳腺癌患者术后吡柔比星（pirarubicin，THP）辅助化疗时的心脏保护作用。方法：将我院乳腺中心和青岛市肿瘤医院肿瘤科治疗的120例应用 CTF（CTX ＋THP＋5－FU）方案化疗的老年乳腺癌患者随机分为观察组和对照组：对照组（不加用 DZR）和观察组（加用 DZR）（DZR∶THP ＝10∶1，即右丙亚胺和吡柔比星的用药剂量比为10∶1）。观察及统计治疗前、治疗第1个周期、第3个周期、治疗第6个周期、治疗完成后半年、治疗完成后1年的心脏事件（心前区疼痛、心率失常、心电图改变、心肌钙蛋白、B 型钠尿肽和左心室射血分数改变、充血性心功能衰竭）发生率，同时观察治疗的非心脏毒性。结果：两组患者在年龄、体重、ECOG 评分和分期方面没有统计学差异（P ＞0．05）。对照组自第1个周期开始心脏事件发生率明显上升，到治疗结束时达到最高，直到治疗后1年仍然维持在较高水平。观察组在治疗期间及治疗后心脏事件发生率较低，两组统计学差异显著（P ＜0．01）。两组的非心脏毒副反应没有明显差异。结论：THP 从第1次应用时对心脏就产生了明显的毒性，加用 DZR 可以降低这种心脏毒性，且毒副反应不明显。

Protective effect of dexrazoxane on the heart in elderly breast cancer patients after adju-vant chemotherapy

Objective:To explore the protective effect of dexrazoxane (DZR)on the heart for postoperative elderly breast cancer patients with pirarubicin (THP)adjuvant chemotherapy.Methods:All 120 elderly breast cancer pa-tients treated with CTF chemotherapy regimens(CTX +THP +5 -FU)in our hospital were randomly assigned into observation group and control group:The control group (without DZR)and observation group (with DZR)(DZR:THP =10∶1).Cardiac functional status and non -cardiac toxicity were observed before treatment,the first cycle of treatment,the third cycle,the sixth cycle of treatment,six months after the completion and one year after the comple-tion,with monitoring the cardiac troponin T (cTnT),B -type natriuretic peptide (BNP)and left ventricular ejection fraction (LVEF).Results:In two groups there were no statistical differences (P >0.05)in age,weight,ECOG score and staging.The cTnT,BNP value of patients in control increased obviously in the first cycle,and reached the maxi-mum at the end of the treatment and maintained at a higher level until one year after treatment.The value of cTnT was low in observation group during treatment and after treatment,while the LVEF level between the two groups had no statistical differences in all stages of treatment (P >0.05).There was no difference in non -cardiac side effects be-tween the two groups.Conclusion:The application of THP has obvious toxicity on the heart.DZR can reduce the car-diac toxicity.