蒽环类药物对乳癌患者心脏毒性的临床研究.pdfVIP

摘 要 蒽环类药物对乳腺癌患者心脏毒性的临床研究 研究生：罗剑锋 导师：崔 洁 副教授 摘 要 目的：探讨蒽环类药物对乳腺癌患者心脏毒性的危险因素，比较吡柔比星与表 柔比星对乳腺癌患者心脏毒性的大小。方法：选择既往无心血管病史、手术后经病 理证实为乳腺癌、无全身其他脏器转移、术前心电图、心肌酶及肌钙蛋白I 均正常的 女性患者 186 例，随机分为吡柔比星组和表柔比星组，两组化疗方案分别为：环磷 酰胺+吡柔比星+5-氟尿嘧啶、环磷酰胺+表柔比星+5-氟尿嘧啶，两组均在术后第 7 天开始化疗，均为锁骨下静脉给药，均以21 天为1 个周期，共化疗6 个周期。分别 记录并比较分析两组患者化疗前后的心电图、心肌酶及肌钙蛋白I 的资料。结果：汉 族和维吾尔族之间、不同肿瘤临床分期之间的心脏毒性差异无统计学意义(P0.05) ， 不同蒽环类药物之间、不同年龄段之间、化疗后不放疗组与化疗后放疗组之间的心 脏毒性差异有统计学意义(P0.05) ；出现心脏毒性者，吡柔比星组42 例，表柔比星 组 57 例，差异有统计学意义(P0.05) 。结论：汉族和维吾尔族之间的民族差异、肿 瘤不同临床分期不是蒽环类药物心脏毒性的危险因素，不同蒽环类药物、年龄、是 否放疗是蒽环类药物心脏毒性的危险因素；表柔比星对乳腺癌患者的心脏毒性大于 吡柔比星。 关键词：吡柔比星；表柔比星；心脏毒性；危险因素 —1— 新疆医科大学医学硕士学位论文 Clinical Research on Cardiotoxicity of Anthracycline in Patients with Breast Cancer Postgraduate: Luo Jianfeng Supervisor: Associate Professor Cui Jie Abstract Objective: To research the risk factors of the cardiotoxicity of chemotherapy with anthracycline in patients with breast cancer, and compare the cardiotoxicity of pirarubicin with epirubicin. Method: A total of 186 patients were divided into pirarubicin group and pirubicin group randomly. All patients, who were confirmed to be breast cancer by pathology, had no angiocardiopathy and their test in ECG, myocardial enzyme and cTnI were normal before the operation. At the same time, their tumor have not been transferred to other organs. Two adjuvant chemotherapy initiated on the 7th day after operation. Patients in the pirarubicin group received threeweekly concurrent cytoxan, p irarubicin and 5-fluorouracil for 6 cycles. The ones in the epirubicin group received threeweekly concurrent cytoxan, epirubicin and 5-