Page 106 - 《中国药房》2022年8期

曲妥珠单抗联合化疗致心脏毒性的影响因素分析 Δ

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朱小丽 ，吕 琛 ，杜雪亭 ，焦甲勋 ，高玲娜 ，孙 霞 ，马红芳 （1.衡水市人民医院药学部，河北 衡水
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053000；2.衡水市人民医院肿瘤内科，河北 衡水 053000；3.衡水市人民医院骨肿瘤科，河北 衡水 053000；
4.衡水市人民医院超声科，河北 衡水 053000）
中图分类号 R969.3；R730.5 文献标志码 A 文章编号 1001-0408（2022）08-0992-04
DOI 10.6039/j.issn.1001-0408.2022.08.15
摘 要 目的 分析曲妥珠单抗联合化疗致人表皮生长因子受体2（HER-2）阳性乳腺癌患者心脏毒性的影响因素。方法 选取在我
院2017年4月－2021年1月接受吡柔比星+环磷酰胺序贯紫杉醇+曲妥珠单抗治疗的HER-2阳性乳腺癌患者200例，根据有无发
生心脏毒性分为发生心脏毒性组和未发生心脏毒性组。收集患者的临床资料及超声心动图检查结果，分析患者发生心脏毒性的
影响因素。结果 200例乳腺癌患者中，发生心脏毒性的有43例，发生率为21.5％。其中，吡柔比星+环磷酰胺治疗期间出现心脏毒
性的患者占 5.5％（11/200），序贯紫杉醇+曲妥珠单抗治疗期间出现心脏毒性的患者占 20.5％（41/200），后者显著高于前者（P＜
0.01）。同时，序贯紫杉醇+曲妥珠单抗治疗期间患者左室射血分数降低幅度显著高于吡柔比星+环磷酰胺治疗期间[14％
（12％，17％）vs. 7％（3％，10％），P＜0.001]。与未发生心脏毒性的患者相比，发生心脏毒性患者中有高脂血症史的占比显著升高
（P＜0.01），而使用右雷佐生的占比显著降低（P＜0.01）。二分类Logistic回归分析结果显示，患者高脂血症史[OR＝3.672，95％CI
（1.499，8.992），P＝0.004]、右雷佐生使用情况[OR＝0.154，95％CI（0.072，0.330），P＜0.001]与心脏毒性的发生相关。结论 高脂血
症史是HER2阳性乳腺癌患者接受吡柔比星+环磷酰胺序贯紫杉醇+曲妥珠单抗致心脏毒性的独立危险因素，而使用右雷佐生则
是保护因素。
关键词 吡柔比星；曲妥珠单抗；心脏毒性；人表皮生长因子受体2阳性乳腺癌；影响因素

Analysis of influential factors of cardiotoxicity induced by trastuzumab combined with chemotherapy
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ZHU Xiaoli ，LYU Chen ，DU Xueting ，JIAO Jiaxun ，GAO Lingna ，SUN Xia ，MA Hongfang（1. Dept. of
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Pharmacy，the People’s Hospital of Hengshui，Hebei Hengshui 053000，China；2. Dept. of Medical Oncology，
the People’s Hospital of Hengshui，Hebei Hengshui 053000，China；3. Dept. of Osteooncology，the People’s
Hospital of Hengshui，Hebei Hengshui 053000，China；4. Dept. of Ultrasound，the People’s Hospital of
Hengshui，Hebei Hengshui 053000，China）
ABSTRACT OBJECTIVE To analyze the influential factors of cardiotoxicity in patients with positive breast cancer of human
epidermal growth factor receptor 2（HER-2）treated by trastuzumab combined with chemotherapy. METHODS From April 2017 to
January 2021，200 HER-2 positive breast cancer patients receiving pirarubicin + cyclophosphamide combined with sequential
paclitaxel+trastuzumab were collected from our hospital. According to the presence or absence of cardiotoxicity，the patients were
divided into cardiotoxicity group and non-cardiotoxicity group. The clinical data and echocardiographic results of the patients were
collected，and the influential factors of cardiotoxicity were analyzed. RESULTS Among 200 patients，43 patients suffered from
cardiotoxicity with the incidence of 21.5％ . The proportion of patients with cardiotoxicity during pirarubicin + cyclophosphamide
therapy accounted for 5.5％（11/200），and the proportion of patients with cardiotoxicity during sequential paclitaxel+trastuzumab
therapy accounted for 20.5％ （41/200）；the latter was significantly higher than the former （P＜0.01）. At the same time，the
decrease of left ventricular ejection fraction during sequential therapy of paclitaxel and trastuzumab was significantly higher than
that during pirarubicin+cyclophosphamide therapy [14％（12％，17％）vs. 7％（3％，10％），P＜0.001]. Compared with patients
without cardiotoxicity，the proportion of patients with cardiotoxicity with a history of hyperlipidemia was significantly higher（P＜
0.01），while the proportion of patients receiving dexrazoxane was significantly lower （P＜0.01）. Results of binary Logistic
regression analysis showed that the history of hyperlipidemia [OR＝3.672，95％ CI（1.499，8.992），P＝0.004] and the use of
dextrazoxane [OR＝0.154，95％ CI （0.072，0.330） ，P＜0.001] were associated with the occurrence of cardiotoxicity.
CONCLUSIONS Hyperlipidemia is an independent risk factor for cardiotoxicity induced by pirarubicin + cyclophosphamide
combined with sequential paclitaxel + trastuzumab in HER2 positive breast cancer patients，while the use of dextrazoxane is a
protective factor.
KEYWORDS pirarubicin； trastuzumab； cardiotoxicity；
Δ 基金项目：河北省2021年度医学科学研究课题计划（No.20211195）
＊副主任药师，硕士。研究方向：肿瘤临床药学。电话：0318- positive breast cancer of human epidermal growth factor
2181239。E-mail：zhuxiaoli_1984@163.com receptor 2；influential factors

·992 · China Pharmacy 2022 Vol. 33 No. 8 中国药房 2022年第33卷第8期