【摘要】 目的探讨表柔比星相关心肌损伤患者血清N端脑钠肽前体(NT-pro BNP)改变及临床意义。方法选择2013年1月至2014年6月于常州市金坛区中医医院住院并接受表柔比星化疗的乳腺癌患者80例,根据是否出现心脏毒性症状分为心脏毒性组(13例)和对照组(67例),动态观察化疗开始前、化疗第2个周期前、第4个化疗周期后1周的超声心动图和NT-pro BNP水平改变。结果化疗后,患者左心功能出现了不同程度的损伤。心脏毒性组患者NT-pro BNP水平在3个检测时间点中逐渐上升(P<0.05)。血清NT-pro BNP水平在化疗的2个周期后和疗程结束后与LVEF呈负相关(P<0.05)。第2个周期前的NT-pro BNP水平具有较高的早期诊断价值,当NT-pro BNP水平升高超过63.7 ng/L时,早期诊断心功能损伤的曲线下面积(AUC)为0.77,灵敏度为75.0%,特异度为82.0%,阳性预测值为0.90,阴性预测值为0.60。结论 NT-pro BNP有望成为早期诊断和预警蒽环类抗生素化疗相关心脏毒性的生物学标志物。更多还原

【Abstract】 Objective To evaluate the changes and clinical significance of N terminal probrain natriuretic peptide( NT-pro BNP) on epirubicin associated cardiac toxicity. Methods Eighty breast cancer patients treated with epirubicin chemotherapy admitted to Changzhou City Jintan Hospital of Traditional Chinese Medicine from Jan. 2013 to Jun. 2014 were divided into two groups: cardiac toxicity group( n = 13) and control group( n = 67). Echocardiography and levels of NT-pro BNP in serum were measured at three time points: the day before chemotherapy,before second chemotherapy cycle and one week after the fourth chemotherapy cycle. Results The patients showed left cardiac function injury of different degrees after chemotherapy. In the group of cardiac toxicity,the levels of NT-pro BNP showed gradual increase at the 3 time points( P < 0. 05). The correlation analysis suggested that the levels of NT-pro BNP showed a negative relationship with LVEF after two cycles of chemotherapy( P < 0. 05). The ROC analysis showed the NT-pro BNP level before the second cycle had high value for early diagnosis. When the level of NT-pro BNP was more than63. 7 ng/L,the AUC,sensibility,specificity,positive predictive value and negative predictive value were0. 77,75. 0%,82. 0%,0. 90 and 0. 60 respectively. Conclusion NT-pro BNP may serve as a convenient serum biomarker for the early detection of cardiotoxicity induced by anthracycline.更多还原