右雷佐生联合磷酸肌酸钠对蒽环类药物致乳腺癌患者心脏损伤的保护作用

目的： 分析右雷佐生联合磷酸肌酸钠对蒽环类药物致乳腺癌患者心脏损伤的预防作用及安全性。方法：收集200例女性乳腺癌患者，随机分为对照组、A组、B组、C组，每组各50例。对照组给予标准剂量的AC或EC方案化疗，A组在对照组基础上给予注射用右雷佐生，B组在对照组基础上给予注射用磷酸肌酸钠，C组在对照组基础上给予右雷佐生及磷酸肌酸钠，3周为1个化疗周期。比较各组化疗后心脏损伤发生率，分析蒽环类药物致心脏毒性的危险因素，并观察化疗前及化疗3个周期后患者心电图、心肌酶、血清B型利钠肽（BNP）和心肌肌钙蛋白I（cTnI）水平、左室射血分数（LVEF），以及不良反应发生率情况。结果：200例乳腺癌患者中，发生心脏损伤49例（24.5%）。4组之间的心脏损伤发生率具有显著差异（P < 0.05），心脏损伤发生率排序为对照组（50.00%） > B组（24.00%） > A组（16.00%） > C组（8.00%）。多因素Logistic回归分析结果显示，心脏保护方案的使用、化疗周期数 ＞ 3、蒽环类药物累积剂量 ＞ 400 mg与心脏损伤的发生相关（P < 0.05）。化疗周期数 > 3、蒽环类药物累积剂量 > 400 mg是蒽环类药物致心脏毒性的独立危险因素，而使用心脏保护剂则是保护因素。对照组化疗后心电图异常发生率高于A、B、C组（P < 0.05）。化疗前各组患者心肌酶、BNP、cTnI、LVEF比较，差异无统计学意义（P > 0.05）；化疗后对照组BNP、cTnI水平高于A、B、C组（P < 0.05）。4组化疗期间不良反应发生率差异无统计学意义（P > 0.05）。结论：右雷佐生联合磷酸肌酸钠用于蒽环类药物致乳腺癌患者心脏损伤有良好的效果且安全性较好。

Protective Effects of Dexrazoxane Combined with Creatine Phosphate on Cardiac Injury by Anthracycline in Breast Cancer Patients

Objective: To analyze the prophylactic effects and safety of dexrazoxane combined with sodium creatine phosphate on cardiac toxicity of anthracycline in patients with breast cancer. Methods: A total of 200 female breast cancer patients were divided into control group, group A, B and C according to the random number table, 50 cases in each group. Patients in the control group were given AC or EC chemotherapy plan; on the basis of AC or EC plan, patients in group A, B or C were additionally given dexrazoxane, creatine phosphate sodium for injection or both. Three weeks was a cycle of chemotherapy. The risk factors of anthracycline cardiotoxicity were analyzed. The changes of electrocardiogram (ECG), myocardial enzymes, serum B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), left ventricular ejection fraction (LVEF) and incidence of adverse reactions were observed before and after 3 cycles of chemotherapy. Results: Among the 200 patients, 49 patients suffered from cardiotoxicity with the incidence of 24.5%. There was a significant difference in the incidence of cardiac injury among the four groups(P < 0.05). The order of cardiac injury incidence was control group(50.00%) > group B(24.00%) > group A(16.00%) > group C(8.00%). The results of binary Logistic regression analysis showed that cardio protective regimen, chemotherapy cycle number > 3, cumulative dose of anthracycline > 400 mg were associated with cardiac injury(P < 0.05). Chemotherapy cycle number > 3, cumulative dose of anthracycline > 400 mg were independent risk factors for anthracycline cardiotoxicity, while the use of cardiac protectants was a protective factor. The abnormal rates of ECG in the A, B, C groups were lower than that in the control group (P < 0.05). No statistically significant differences of serum level of CK, CK-MB, BNP or cTnI were found among the groups before treatment (P > 0.05). After chemotherapy, the levels of BNP and cTnI in the control group were significantly higher than those in the test groups (P < 0.05), while there was no significant difference in the incidence of adverse reactions among the groups (P > 0.05). Conclusion: Dexrazoxane combined with creatine phosphate sodium is effective and safe in the treatment of anthracicline induced cardiac damage in patients with breast cancer.