坎地沙坦联合小剂量卡维地洛或右丙亚胺对乳腺癌患者使用蒽环类化疗药物过程中的心脏保护作用对比研究

摘要

目的 对比研究坎地沙坦联合小剂量卡维地洛或右丙亚胺对乳腺癌患者使用蒽环类化疗药物过程中的心脏保护作用.方法 对104例乳腺癌患者的临床资料进行回顾性研究,按照不同治疗方式将患者分为试验组与对照组,每组52例.对照组患者在化疗方案中加用右丙亚胺;试验组患者在化疗方案中加用坎地沙坦联合小剂量卡维地洛.比较两组患者在治疗前以及治疗4、8个周期后心电图变化、肌钙蛋白水平、心肌重构指标以及不良反应发生情况.结果 化疗8个周期后,试验组患者QRS波群电压下降、心律失常、ST-T异常发生率明显低于对照组(P﹤0.01).化疗前两组患者LVEF、LVEDD及BNP比较,差异无统计学意义(P﹥0.05);化疗4、8个周期后,试验组患者LVEF下降程度低于对照组,LVEDD、BNP上升程度低于对照组(P﹤0.01).两组患者化疗4个周期后肌钙蛋白异常情况发生率比较,差异无统计学意义(P﹥0.05),化疗过程中两组患者未发生明显的肌钙蛋白异常情况(P﹥0.05).两组患者不良反应发生率比较,差异无统计学意义(P﹥0.05).结论 坎地沙坦联合小剂量卡维地洛能降低蒽环类化疗药物对癌症患者的心脏不良反应,且不良反应较轻,可在乳腺癌化疗患者中推广使用.%Objective To compare and investigate the cardioprotective effects of candesartan combined with low-dose carvedilol and dexrazoxane in breast cancer patients treated by anthracycline chemotherapy.Method The clinical data of 104 patients with breast cancer were retrospectively reviewed.The patients were divided into study group or con-trol group(52 cases in each)by respective therapy administered.Patients in the control group were treated with dexrazox-ane combined with chemotherapy regimen; while patients in study group were treated with candesartan combined with low-dose carvedilol.The changes of electrocardiogram,troponin,myocardial remodeling and adverse events were com-pared between the two groups before and after 4 and 8 cycles of treatment,respectively.Result After 8 cycles of treat-ment,the incidence of decreased QRS complex voltage,arrhythmia and ST-T abnormality in study group was significant-ly lower than that in the control group(P<0.01).No significant difference was detected in LVEF,LVEDD and BNP be-tween the two groups before chemotherapy(P>0.05);greater decrease of LVEF,and more increase of LVEDD and BNP were observed in study group than in the control group after 4 and 8 cycles of chemotherapy(P<0.01).No difference was detected in the incidence of troponin abnormalities after 4 cycles of chemotherapy in the two groups(P>0.05),and there were no obvious abnormalities of troponin in the two groups during chemotherapy.No difference was noted in regard of the incidence of adverse reactions between the two groups(P>0.05).Conclusion Candesartan combined with low-dose carvedilol can reduce the cardiac toxicities caused by anthracycline chemotherapy in cancer patients,with mild adverse re-actions,and is clinically applicable in breast cancer patients during chemotherapy.