本文選題：乳腺腫瘤 + 糖尿病��； 參考：《中國(guó)全科醫(yī)學(xué)》2017年15期

【摘要】：目的分析目前臨床常用的以表阿霉素為基礎(chǔ)的化療對(duì)合并糖尿病的女性乳腺癌患者的心臟毒性。方法選擇2013年10月—2015年10月于河北醫(yī)科大學(xué)第四醫(yī)院乳腺中心行根治性腫瘤切除術(shù)后經(jīng)病理檢查明確為診斷乳腺癌的女性患者108例,均預(yù)行以表阿霉素為基礎(chǔ)的化療(表阿霉素+環(huán)磷酰胺),3周為1個(gè)療程,共6個(gè)療程。其中合并2型糖尿病患者55例作為糖尿病化療組,不合并糖尿病患者53例作為非糖尿病化療組。同時(shí)期于內(nèi)分泌科門診入選年齡匹配的無(wú)乳腺癌的女性2型糖尿病患者50例作為糖尿病對(duì)照組。乳腺癌患者均于應(yīng)用化療方案前(基線時(shí))及化療結(jié)束后、糖尿病對(duì)照組于入組時(shí)及4.5個(gè)月后測(cè)定常規(guī)指標(biāo)、多普勒超聲檢查指標(biāo)及氧化應(yīng)激指標(biāo)。結(jié)果糖尿病化療組最終入選50例患者,非糖尿病化療組最終入選50例患者�；�時(shí),糖尿病化療組與糖尿病對(duì)照組總膽固醇、三酰甘油、糖化血紅蛋白均高于非糖尿病化療組(P0.05);化療結(jié)束后,3組患者Δ體質(zhì)指數(shù)、Δ血壓、Δ血紅蛋白、Δ總膽固醇、Δ三酰甘油、Δ糖化血紅蛋白比較(P0.05)�；�時(shí),糖尿病化療組及糖尿病對(duì)照組左房室瓣舒張?jiān)缙谘魉俣?左房室瓣舒張?jiān)缙谶\(yùn)動(dòng)速度(E/Ea)高于非糖尿病化療組(P0.05);化療結(jié)束后,糖尿病化療組ΔEa低于糖尿病對(duì)照組及非糖尿病化療組,ΔE/Ea高于糖尿病對(duì)照組及非糖尿病化療組(P0.05)�；�時(shí),糖尿病化療組及糖尿病對(duì)照組血清超氧化物歧化酶(SOD)低于非糖尿病化療組,丙二醛(MDA)高于非糖尿病化療組(P0.05);化療結(jié)束后,3組ΔSOD、ΔMDA組間兩兩比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論以表阿霉素為基礎(chǔ)的化療導(dǎo)致女性乳腺癌合并糖尿病患者出現(xiàn)了明顯加重的心臟舒張功能受損,提示同時(shí)合并糖尿病加重了以表阿霉素為基礎(chǔ)的化療對(duì)心臟的損害。
[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.
【作者單位】： 河北醫(yī)科大學(xué)第四醫(yī)院心內(nèi)科;河北中醫(yī)學(xué)院藥學(xué)院;河北醫(yī)科大學(xué)第四醫(yī)院科研處;河北醫(yī)科大學(xué)第四醫(yī)院神經(jīng)外科;
【分類號(hào)】：R587.1;R737.9

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