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:
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
基金项目:
作者单位
黄 平 浙江省肿瘤医院 
陈俊英 浙江省肿瘤医院 
陈占红 浙江省肿瘤医院 
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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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