心肌钙蛋白Ⅰ联合心电图预测乳腺癌TA化疗方案的心脏毒性的价值(1)
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[摘要] 目的 分析心肌钙蛋白I(CTn I)联合体表心电图对接受TA方案化疗的乳腺癌患者心脏毒性的预测价值。方法 选取137例乳腺癌患者，通过15导联心电图检查患者化疗前后的心脏节律及R波振幅、ST-T变化，并记录化疗前后患者CTnI浓度、左心室射血分数(LVEF)。结果 化疗前患者血清CTnI浓度为(0.014±0.012)ng/L，体表心电图检查无异常；化疗第一疗程、第二疗程和第三疗程后患者血清CTnI浓度分别增加到(0.034±0.013)ng/L、(0.121±0.046)ng/L和(0.238±0.128)ng/L，且LVEF下降超过10%的患者人数分别达到36、54和71例，同时化疗后1天、1周、1个月时患者的心电图异常率分别为82.5%、55.47%和40.0%。结论 CTnI联合心电图可作为早期预测TA化疗方案引起心脏毒性的指标。
[关键词] 心肌蛋白Ⅰ；心电图；乳腺癌；阿霉素化疗；心脏毒性
[中图分类号] R737.9 [文献标识码] B [文章编号] 1673-9701(2011)33-17-02
Value of Cardiac TroponinⅠ and Electrocardiography Measurement in Prediction of TA-induced Cardiotoxicity in Breast Cancer Patients
HUANG Jie LI Simin LIANG Jinhua
Cancer Center of the Second People’s Hospital of Zhanjiang City in Guangdong Province，Zhanjiang 524003，China
[Abstract] Objective To analyze the value of cardiac troponin I(CTn I)and electrocardiography measurement in predicting TA-induced cardiotoxicity in patients with breast cancer. Methods This study was conducted among 137 breast cancer patients，to investigate the heart rhythm，the voltage of R wave，the change of ST-T by 15-lead ECGs and serum CTnI concentrations and the left ventricular ejection fraction(LVEF)before and after each cycle of the chemotherapy. Results The serum CTnI concentrations of patients were(0.014±0.012)ng/L and no abnormal ECGs before the chemotherapy. After the first period of chemotherapy，the second course and the third course， the serum CTnI concentrations of patients increased to(0.034±0.013)ng/L、(0.121±0.046)ng/L、(0.238±0.128)ng/L and the number of patients with a LVEF reduction by over 10% were 36、54 and 71 separately. Furthermore， the incidence of abnormal ECGs were 82.5%、55.47% and 40.0%. Conclusion CTnI and electrocardiography can be a useful marker for early prediction of TA-induced cardiotoxicity in patients with breast cancer.
[Key words] Cardiac troponin I；Electrocardiography；Breast cancer；TA；Cardiotoxicity
新辅助化疗是降低晚期乳腺癌局部术后发生复发和转移的发生率及提高生存率和生活质量的重要治疗措施[1]。临床研究发现，泰素+阿霉素的新辅助化疗方案治疗乳腺癌患者有良好的疗效。但Swain等[2]研究表明，阿霉素类药物累积会造成患者心脏毒性，当接受剂量达到500mg/m2时，出现CIIF的比例高达16%，接受累积剂量为400mg/m2、550mg/m2、700mg/m2的阿霉素类药物治疗时CIIF的发生率分别为5%、26%、48% ......
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