Objective To analyze the effect of epirubicin-based chemotherapy on cardiotoxicity of breast cancer female patients combined with diabetes.Methods A total of 108 female patients underwent radical resection of the tumor in the breast center of Fourth Hospital of Hebei Medical University from October 2013 to October 2015 were selected and were clearly diagnosed with breast cancer after the pathological examination.The epirubicin-based chemotherapy(epirubicin+cyclophosphamide) was conducted firstly,3 weeks a course and totally 6 courses.Among the subjects,55 patients combined with type 2 diabetes were assigned into diabetic chemotherapy group and 53 patients not combined with diabetes were assigned into non-diabetic chemotherapy group.At the same time,50 age-matched female diabetic patients without breast cancer in the outpatient of endocrinology department were selected as the diabetic control group.Measurement of routine indicators,Doppler ultrasound inditators,and oxidative stress indicators were conducted to patients with breast cancer before the application of chemotherapy regimens(baseline) and after chemotherapy,and to patients in diabetic control group at the time of enrollment and after 4.5 months.Results Fifty patients were selected from diabetic chemotherapy group and non-diabetic chemotherapy group respectively.At baseline,total cholesterol,triglyceride and glycosylated hemoglobin in diabetic chemotherapy group and diabetic control group were higher than those in non-diabetic chemotherapy group(P<0.05).There were no significant differences in Δbody mass index,Δblood pressure,Δhemoglobin,Δtotal cholesterol,Δtriglyceride and Δglycosylated hemoglobin among patients in the three groups after chemotherapy(P>0.05).At baseline,E/Ea in diabetic chemotherapy group and diabetic control group was higher than that in non-diabetic chemotherapy group(P<0.05).At the end of chemotherapy,ΔEa in diabetic chemotherapy group was significantly lower than that in diabetic control group and non-diabetic chemotherapy group,and its ΔE/Ea was significantly higher than that in diabetic control group and non-diabetic chemotherapy group(P<0.05).At baseline,SOD in diabetic chemotherapy group and diabetic control group was lower than that in non-diabetic chemotherapy group,MDA was higher than that in non-diabetic chemotherapy group(P<0.05).After chemotherapy,there were significant differences in ΔSOD and ΔMDA in pairwise comparison between groups(P<0.05).Conclusion The epirubicin-based chemotherapy leads to a significant aggravation in diastolic dysfunction among female breast cancer patients combined with diabetes,and indicates that combination of diabetes aggravates themyocardial damage of the epirubicin-based chemotherapy.%目的 分析目前临床常用的以表阿霉素为基础的化疗对合并糖尿病的女性乳腺癌患者的心脏毒性.方法 选择2013年10月-2015年10月于河北医科大学第四医院乳腺中心行根治性肿瘤切除术后经病理检查明确为诊断乳腺癌的女性患者108例,均预行以表阿霉素为基础的化疗(表阿霉素+环磷酰胺),3周为1个疗程,共6个疗程.其中合并2型糖尿病患者55例作为糖尿病化疗组,不合并糖尿病患者53例作为非糖尿病化疗组.同时期于内分泌科门诊入选年龄匹配的无乳腺癌的女性2型糖尿病患者50例作为糖尿病对照组.乳腺癌患者均于应用化疗方案前(基线时)及化疗结束后、糖尿病对照组于入组时及4.5个月后测定常规指标、多普勒超声检查指标及氧化应激指标.结果 糖尿病化疗组最终入选50例患者,非糖尿病化疗组最终入选50例患者.基线时,糖尿病化疗组与糖尿病对照组总胆固醇、三酰甘油、糖化血红蛋白均高于非糖尿病化疗组(P<0.05);化疗结束后,3组患者Δ体质指数、Δ血压、Δ血红蛋白、Δ总胆固醇、Δ三酰甘油、Δ糖化血红蛋白比较(P>0.05).基线时,糖尿病化疗组及糖尿病对照组左房室瓣舒张早期血流速度/左房室瓣舒张早期运动速度(E/Ea)高于非糖尿病化疗组(P<0.05);化疗结束后,糖尿病化疗组ΔEa低于糖尿病对照组及非糖尿病化疗组,ΔE/Ea高于糖尿病对照组及非糖尿病化疗组(P<0.05).基线时,糖尿病化疗组及糖尿病对照组血清超氧化物歧化酶(SOD)低于非糖尿病化疗组,丙二醛(MDA)高于非糖尿病化疗组(P<0.05);化疗结束后,3组ΔSOD、ΔMDA组间两两比较,差异均有统计学意义(P<0.05).结论 以表阿霉素为基础的化疗导致女性乳腺癌合并糖尿病患者出现了明显加重的心脏舒张功能受损,提示同时合并糖尿病加重了以表阿霉素为基础的化疗对心脏的损害.
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