还原型谷胱甘肽预防表阿霉素心脏毒性的观察

• 754•中N垛&现论与实践 2008 年 8 月笫丨4 卷策 8 期 Chin J Rchabil Theory Pract. A UR. 2008. Vol. 14, No. 8

•临床研究•

还原型谷胱甘肽预防表阿霉素心脏毒性的观察

宫艳丽，张清媛

[摘要] 目的观察外源性还原型谷胱甘肽（GSH）预防表阿霉素心脏毒性的疗效.方法60例乳腺癌术后患者随机分为治疗组和对照组，各30例。治疗组接受连续6个周期CEF方案化疗+ GSH治疗：对照组仅采用CEF方案化疗。化疗前、化疗3个周期及6个周期后，利用心电图、心肌酶、肌钙蛋白1 (cTnⅠ)、常规超卢心动图及组织多普勒超声技术评价两组患者化疗后的心脏毒性。结果化疗3个周期后，两组患者的心电改变、cTnⅠ损伤情况、左心室射血分数（EF)、左心室短轴缩短率（FS)、二尖瓣舒张早期流速峰值/舒张晚期流速峰值（E/A）、E峰流速时间（DT)、心肌肌酸激酶（CK)、肌酸激酶间工酶（CK-MB)、乳酸脱氢酶（LDH)等无显著性差异（P >0.05),舒张功能参数Em/Am有非常显著性差异（P<0.01),化疗6个周期后，两组患者的EF、FS、心肌酶CK、CK-MB、LDH无显著性差异（P>0.05);心电改变、cTtiⅠ损伤悄况有显著性差异（P<0.05);舒张功能参数E/A、DT、Em/ Am有非常显著性差异（P<0.01）。结论GSH对表阿霉素引起的心脏毒性有防治作用，机制可能与GSH的抗氧化及抑制钙超载有关。

[关键词]还原细谷胱甘肽；表阿筘索；心脏毋性；顼防作用

Prophylactic Effect of Reduced Glutathione on Cardioloxicity Induced by Epirubicin GONG Yan-li f ZHANG Qing-yuan. Tumor Hospital of Harbin Medical Vniuersity * Harbin 150040. Heilongjiang% China

Abstract] Objective To explore the efficacy and mechanism of exogenous reduced glutathione (GSH) on cardiotoxicily induced by epirubicin (EPI). Methods 60 postoperative patients with breast cancer were randomly divided into the treatment group and control group with 30 cases in each group. The treaimcm group received 6 cycles of chemotherapy with CEF regimen plus the reduced GSH. The control group also received 6 cycles of chemotherapy only with CEF alone. The cardiotoxicity of all patients were estimated by the ECG» myocardial enzymes, troponin I (cTn I ), ultrasoundcardiogram and tissue Doppler technique before hemother apy and after 3 cycles and 6 cycles of chemotherapy. Results After 3 cycles of chemotherapy» there were no significant differences in ECG f cTn I « left ventricle ejection fraction (EF), fraction shortening (FS)» E/A. decline time (I)T) and myocardial creatine kinase (CK). isoenzyme of creatine kinase containing M and B subunits 0. 05)» While» there was a significant difference in Em/Am between two groups ( P0. 05)* there were significant differences in ECG, cTnl，E/A. I)T and Em/Am between two groups ( P <0. 01). Conclusion The reduced GSH can prevenl the cardiotoxicicy induced by EP1» which may be related with the ability of GSH against the oxidant injury and inhibiting calcium overload.

Key words： reduced glutathione；epirubicin；cardiotoxicilyiprophylactic effect

[中图分类号]R730.53 [文献标识码]A [文章编号]1006-9771（2008）08-0754-03

[本文著录格式]宫艳丽，张淸嬡。还原型谷胱甘肽预防表阿霉素心脏毒性的观察[J].中国康复理论与实践，2008，14(8): 754—756.

表阿霉素（epirubicin，EPI)是临床最常用的一种蒽环类抗肿瘤药物（amhracycline.ATC)，用于治疗多种恶性肿瘤。但由于该药有剂量累积心脏毒性，故不能广泛和长期使用。近年来，国内外在预防ATC心脏毒性方面进行了一定的探索，尤其注重研究和开发保护心脏的药物，取得了一定的成效。本研究旨在探讨还原型谷胱甘肽（reduced glutathione,GSH>作为一种氧自由基淸除剂和钙拮抗剂，对ATC引起的心脏毒性的保护作用。1资料与方法

作者单位：哈尔滨医科大学附属肿瘤医院.黑龙江哈尔滨市150040.作名简介：宫艳丽（1970-)，女，黑龙江牡丹江市人，主治医师，碩士研究生•主要研究方向：恶性肿瘤化疗.通汛作者：张清嫒，

1.1临床资料哈尔滨医科大学附属肿瘤医院2007 年8月〜2008年2月住院患者60例，均为女性，经病理学检查证实为乳腺癌，其中浸润性导管癌39例、小叶癌6例、髄样10例、单纯癌5例；行乳腺癌根治术或改良根治术后需