| 黄 平,陈俊英,陈占红.乳腺癌患者曲妥珠单抗治疗的耐受性及心功能监测[J].肿瘤学杂志,2012,18(12):930-934. |
| 乳腺癌患者曲妥珠单抗治疗的耐受性及心功能监测 |
| Tolerance and Cardiac Function Monitoring During Trastuzumab Treatment for Breat Cancer Patient |
| 投稿时间：2012-09-25 |
| DOI： |
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| 中文关键词: 曲妥珠单抗 耐受性 心脏毒性 左室射血分数 药物疗法 乳腺肿瘤 |
| 英文关键词:trastuzumab tolerance cardiac toxicity left ventricular ejection fraction drug therapy breast neoplasms |
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| 中文摘要: |
| 摘 要： ［目的］ 观察乳腺癌患者曲妥珠单抗治疗过程中的临床耐受性及心脏安全性。［方法］ 对Her-2基因过表达82例女性乳腺癌患者在曲妥珠单抗使用过程中进行心电图监测。记录出现的心脏相关症状。采用超声心动图法，分别于曲妥珠单抗使用前1个月及使用后每3个月监测1次左室射血分数（LVEF）。［结果］ 曲妥珠单抗使用过程中心脏相关症状主要为胸闷、心悸及呼吸困难。心电图异常主要表现为ST-T段改变、窦性心动过速、传导阻滞、窦性心动过缓。以上不良事件的程度绝大多数为Ⅰ~Ⅱ度。监测3、6、9、12、15个月时的LVEF均值分别为69.93%±5.72%、70.64%±5.12%、71.03%±5.31%、70.29%±5.10%、69.08%±5.84%，与基线时比较均有下降，但均未出现低于50%的病例。在监测15个月过程中，LVEF平均下降幅度介于4.35%~2.10%之间。监测3、6、9、12、15个月时LVEF下降幅度≥16%患者的比例分别为4.00%、2.99%、2.17%、2.78%和4.35%。蒽环类药物经治的患者在曲妥珠单抗使用第3、6、9、12、15个月监测到LVEF下降≥10%的比例分别为15.40%、11.90%、14.30%、22.7%和20.00%。并没有发现明显高于未使用过蒽环类的患者。［结论］ 乳腺癌患者在曲妥珠单抗治疗期间都伴随着LVEF水平的降低，但是随着治疗时间的延长并没有发现LVEF的进行性下降，患者的总体耐受性良好，说明治疗期间的定期监测十分重要。 |
| 英文摘要: |
| Abstract: ［Purpose］: To observe the clinical tolerance and cardiac safety of trastuzumab in the treatment for breast cancer patients. ［Methods］ ECG monitoring were carried out in the process of the treatment of trastuzumab in 82 female cases with breast cancer with Her-2 gene overexpression，and heart associated symptoms were recorded. Left ventricular ejection fraction（LVEF）was monitored by echocardiography 1 month before treatment of trastuzumab and every 3 months after treatment of trastuzumab. ［Results］ Trastuzumab related cardiac symptoms were mainly chest distress，palpitation and dyspnea. The common electrocardiographic abnormalities were ST-T segment change，sinus tachycardia，conduction block，and sinus bradycardia，majority with degreesⅠorⅡ. The mean value of LVEF at the time of 3，6，9，12 and 15 months were 69.93%±5.72%，70.64%±5.12%，71.03%±5.31%，70.29%±5.10%，69.08%±5.84%，respectively，lower than the baseline，but there were no case with LVEF less than 50%. During 15 months of monitoring，LVEF declined average in 4.35%～2.10%. Patients with LVEF decline≥16% in monitoring of 3，6，9，12，15 months accounted for 4.00%，2.99%，2.17%，2.78% and 4.35% respectively. LVEF decline≥10% at monitoring of 3，6，9，12，15 months were found respectively at 15.40%，11.90%，14.30%，22.70% and 20.00% of patients with anthracycline treatment before trastuzumab use. No case with LVEF significantly higher than the patients without anthracycline treatment was found. ［Conclusion］ A decrease in LVEF level might be found in breast cancer patients treated with trastuzumab，but with the prolonged treatment time，LVEF progressive decrease does not appear，and the patients are well-tolerable. Periodic monitoring during trastuzumab treatment is very important. |
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