以表阿霉素为基础的化疗对乳腺癌合并糖尿病患者心脏毒性的影响

发布时间：2018-07-02 09:58

本文选题：乳腺肿瘤 + 糖尿病　；参考：《中国全科医学》2017年15期

【摘要】：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(P0.05);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(P0.05)。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(P0.05);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(P0.05)。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(P0.05);化疗结束后,3组ΔSOD、ΔMDA组间两两比较,差异均有统计学意义(P0.05)。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。
[Abstract]:Objective to analyze the cardiac toxicity of epirubicin-based chemotherapy to female breast cancer patients with diabetes mellitus. Methods 108 female patients with breast cancer diagnosed by pathological examination were selected from October 2013 to October 2015 in the breast center of the fourth Hospital of Hebei Medical University. All patients were treated with epirubicin based chemotherapy (epirubicin cyclophosphamide) for 3 weeks. 55 patients with type 2 diabetes were treated as diabetic chemotherapy group and 53 patients without diabetes mellitus as non-diabetic chemotherapy group. At the same time, 50 women with type 2 diabetes without breast cancer were enrolled in the Endocrinology Clinic as the diabetic control group. Patients with breast cancer were treated with chemotherapy (baseline) and after chemotherapy. The diabetic control group was tested for routine index, Doppler ultrasound index and oxidative stress index at the time of admission and 4.5 months after chemotherapy. Results 50 patients were enrolled in the diabetic chemotherapy group and 50 patients in the non-diabetic chemotherapy group. Baseline, total cholesterol and triglyceride in the diabetic chemotherapy group and the diabetic control group, Glycosylated hemoglobin was higher than that of non-diabetic chemotherapy group (P0.05); 螖 body mass index, 螖 blood pressure, 螖 hemoglobin, 螖 total cholesterol, 螖 triglyceride, 螖 glycosylated hemoglobin were compared in three groups after chemotherapy (P0.05). At baseline, the early diastolic velocity of left atrioventricular valve / early diastolic velocity of left atrioventricular valve (E / EA) in the diabetic chemotherapy group and the diabetic control group was higher than that in the non-diabetic chemotherapy group (P0.05). 螖 EA in diabetic chemotherapy group was lower than that in diabetic control group and non-diabetic chemotherapy group, 螖 E / EA was higher than that in diabetic control group and non-diabetic chemotherapy group (P0.05). At baseline, the levels of serum superoxide dismutase (SOD) and malondialdehyde (MDA) in the diabetic chemotherapy group and the diabetic control group were lower than those in the non-diabetic chemotherapy group (P0.05), and there were significant differences in 螖 SOD and 螖 MDA between the three groups after chemotherapy (P0.05). Conclusion chemotherapy based on epirubicin may result in impaired cardiac diastolic function in women with breast cancer and diabetes mellitus, which suggests that the heart damage caused by epirubicin based chemotherapy is aggravated by diabetes mellitus at the same time.
【作者单位】：河北医科大学第四医院心内科;河北中医学院药学院;河北医科大学第四医院科研处;河北医科大学第四医院神经外科;
【分类号】：R587.1;R737.9

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