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目的:分析使用蒽环类化学药物方案治疗对不同年龄阶段乳腺癌患者心脏功能的影响。方法:选择2012年2月~2015年2月乳腺癌患者80例,依据发病年龄阶段不同分为青年组(40例)与老年组(40例)。2组患者均给与蒽环类药物治疗方案,采用免疫化学发光法检测血清钠尿肽(BNP,pg/mL)、免疫荧光定量测定血清肌钙蛋白I(cTn I,ng/mL),对比分析2组患者化疗后心电图异常发生率。结果:治疗前,2组患者临床肿瘤分期差异无统计学意义(P>0.05),年龄、肿瘤大小、ER+、PR+、HER-2+率差异有统计学意义(P<0.05)。治疗前后比较,老年组患者血清BNP水平[(149.54±23.85)pg/mL比(376.45±19.48)pg/mL,t=2.985]、cTn I[(0.036±0.002)ng/mL比(0.987±0.015)ng/mL,t=3.096]明显升高,组内比较差异有统计学意义(P<0.05)。青年组患者血清BNP水平[(143.72±21.59)pg/mL比(189.65±17.49)pg/mL,t=2.694]、cTn I[(0.037±0.003)ng/mL比(0.054±0.005)ng/mL,t=1.583]略升高,组内比较差异有统计学意义(P<0.05)。治疗后,老年组较青年组比较,血清BNP、cTn I水平升高,2组比较差异有统计学意义(P<0.05)。治疗后,老年组与青年组心电图变化率比较,ST-T下移变化[(15/40,37.50%)比(6/40,15.50%),X2=3.658]、房性早搏发生变化率[(15/40,37.50%)比(6/40,15.00%),X2=3.471]、T波倒置发生变化率[(13/40,32.50%)比(3/40,7.50%),X2=3.789]、PR间期延长变化率[(8/40,20.00%)比(2/40,5.00%),X2=3.905]、Q-T间期延长变化率[(7/40,17.50%)比(1/40,2.50%),X2=3.542]明显增多,2组比较差异有统计学意义(P<0.05)。结论:蒽环类化疗药物对于不同年龄阶段患者心脏功能影响不同,其中,以老年乳腺癌患者心脏损伤几率较大。对于老年乳腺癌术后使用蒽环类药学药物治疗患者应该注意心脏功能保护,血清肌钙蛋白I与钠尿肽水平动态变化有助于患者心肌损伤的早期监测。
OBJECTIVE: To analyze the effects of anthracycline regimen on cardiac function in breast cancer patients of different ages. Methods: Eighty breast cancer patients from February 2012 to February 2015 were divided into the young group (40 cases) and the elderly group (40 cases) according to the age of onset. The patients in both groups were given anthracycline regimen, serum BNP (pg / mL) was measured by immunochemiluminescence and cTn I, ng / mL was quantified by immunofluorescence Analysis of two groups of patients after chemotherapy, the incidence of abnormal ECG. Results: There was no significant difference in clinical staging between the two groups before treatment (P> 0.05). There were significant differences in age, tumor size, ER +, PR + and HER-2 + rates between the two groups (P <0.05). The levels of serum BNP were significantly higher in the elderly group than those in the elderly group [(149.54 ± 23.85) pg / mL (376.45 ± 19.48) pg / mL, t = 2.985] and cTn I [(0.036 ± 0.002) ) ng / mL, t = 3.096], the difference was statistically significant (P <0.05). Serum BNP levels in young patients [(143.72 ± 21.59) pg / mL (189.65 ± 17.49) pg / mL, t = 2.694] and cTn I [(0.037 ± 0.003) , t = 1.583] slightly increased, the difference was statistically significant (P <0.05). After treatment, the levels of serum BNP and cTn I in the elderly group were significantly higher than those in the young group. There was significant difference between the two groups (P <0.05). After treatment, the change rate of ST-T in the elderly group and the young group was lower than that of the young group [(15/40, 37.50%) vs (6/40, 15.50%), X2 = 3.658] (15/40, 37.50%) (6/40, 15.00%), X2 = 3.471], the rate of change of T wave inversion was (13/40, 3.789]. The change rate of PR interval prolongation [(8/40, 20.00%) vs (2/40, 5.00%), X2 = 3.905] 1 / 40,2.50%), X2 = 3.542] increased significantly, the difference between the two groups was statistically significant (P <0.05). Conclusion: Anthracyclines have different effects on heart function in patients of different age groups. Among them, elderly patients with breast cancer have a higher risk of heart damage. For elderly patients with anthracycline after surgery for breast cancer should pay attention to cardiac function protection, serum troponin I and the level of natriuretic peptide dynamic changes in patients with myocardial damage early monitoring.