目的 探讨右丙亚胺对柔红霉素所致心脏毒性的防治作用.方法 观察10例急性非淋巴细胞白血病患者,在接受含柔红霉素化疗时合用右丙亚胺后心电图及左室射血分数(EF)的变化.并与未使用右丙亚胺的对照组12例作比较.结果 在柔红霉素方案化疗1个疗程后,右丙亚胺组与对照组心电图异常发生率分别为10.0%(1/10)和25.0%(3/12),左室EF下降超过10%的发生率分别为10%(1/10)和16.7%(2/12),两者差异均无统计学意义.3个疗程后,右丙亚胺组与对照组心电图异常发生率分别为20.0%(2/10)和50.0%(6/12),左室EF分数下降超过10%的发生率分别为20.0%(2/10)和41.7%(5/12)(P＜0.01).对产生心脏毒性的8例患者,在其后再次接受含柔红霉素方案化疗时联合使用右丙亚胺,2个疗程结束后有5例患者异常心电图转为正常,4例患者EF分数得到恢复,无一例心脏损害加重.结论 右丙亚胺对柔红霉素所致心脏毒性的发生有一定的防护作用,并且对已经形成的损害有一定的修复作用.%Objective To investigate the protective effects of dexrazoxane on daunorubicin cardiotoxicity.Methods Patients with acute non - lymphoid leukemia were enrolled into chemotherapy group ( Group A, 12 cases ) and dexrazoxane combined chemotherapy group ( Group B, 10 cases ). ECG and evaluation of ejection fraction ( EF ) were carried out after each course of chemotherapy. Results After the 1st course of chemotherapy, the incidences of ECG abnormal were 25.0％ ( 3/12 ) and 10. 0％ ( 1/10 ) in the Group A and B, respectively. Meanwhile, incidences of EF reduced by more than 10％ were 16.7％ ( 2/12 ) and 10. 0％ ( 1/10 ) in Group A and B, respectively. No significant difference was revealed between the two groups. After the 3rd course of chemotherapy, the incidences of abnormal ECG were 50. 0％( 6/12 ) and 20. 0％ ( 2/10 ) in Group A and B, respectively. Meanwhile, the incidences of EF reduced by more than 10％ were 41.7％ ( 5/12 ) and 20. 0％ ( 2/10 ) in Group A and B, respectively. There were significant differences between the two groups ( P ＜0. 01 ). Patients with abnormal ECG and reduced EF for more than 10％ ( 8 and 7 cases, respectively ) were subsequently treated with 2 courses of dexrazoxane. Recovery of ECG and EF was observed in 5 and 4 patients, respectively without recurrence. Conclusion Dexrazoxane confers cardiac protection against daunorubicin cardiotoxicity and reverses daunorubicin - induced heart injury.
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