通脉四逆汤加减对乳腺癌患者化疗后早期心肌损伤的临床观察

通脉四逆汤加减对乳腺癌患者化疗后早期心肌损伤的临床观察*

龙惠东①　林云恩①　梁仕香①　刘雪梅①　刘观成①　萧结容①

【摘要】　目的：观察通脉四逆汤加减对乳腺癌患者化疗所致早期心肌损伤的影响。方法：确诊为乳腺癌患者，按随机抽号法分为对照组和通脉四逆汤组，每组各30例。对照组采用单纯化疗（TAC方案），通脉四逆汤组在此基础上补充通脉四逆汤加减。对比分析两组患者心电图异常发生率，超声心动图测量各心功能指标，包括左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、心脏早晚期血流峰值比值（E/A ratio），检测心肌损伤生化标志物，包括血清肌钙蛋白T（cTnT）、肌酸激酶-MB同工酶（CK-MB）、血浆N末端B型利钠肽原（NT-proBNP）和炎症因子超敏C-反应蛋白（hs-CRP）水平。结果：与化疗前相比较，化疗后两组心律失常率较前增加，差异有统计学意义（P<0.05），但通脉四逆汤组心律失常发生率低于对照组，差异无统计学意义（P>0.05）；心功能指标（LVEF、LVEDD）及血清cTnT、CK-MB，通脉四逆汤组均较对照组有所改善，但差异均无统计学意义（P>0.05）。化疗后，通脉四逆汤组E/A 比值升高、血浆NT-proBNP和炎症因子hs-CRP下降，三指标较对照组明显改善，差异均有统计学意义（P<0.05）。结论：通脉四逆汤加减改善心功能及心脏损伤指标，其舒张功能指标E/A rario和血浆NT-proBNP较心脏彩超监测收缩功能指标LVEF及心脏结构改变更早出现，更能反映亚临床心脏损伤程度，炎症因子hs-CRP下降，说明该汤剂可能通过改善心肌的炎症损伤达到较好的心脏保护作用。

【关键词】　通脉四逆汤；　乳腺癌；　化疗；　心肌损伤

Clinical Research of Tongmai Sini Decoction Add and Subtracton on Chemotherapy-induced Early Myocardial Injury in Breast Cancer/LONG Huidong，LIN Yun’en，LIANG Shixiang，et al.//Medical Innovation of China，2019，16（25）：126-130

【Abstract】　Objective：To observe the effects of Tongmai Sini decoction add and subtracton chemotherapy-induced early myocardial injury in breast cancer.Method：A total of 60 patients with breast cancer were randomly divided into control group and Tongmai Sini Decoction group，30 cases in each group.The control group was given TAC chemotherapy regimen was used.On the base of the treatment as the control group，another group was given the Tongmai Sini Decoction.The incidence of arrhythmia in electrocardiogram，left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD） and ratio of peak early to late diastolic filling velocity （E/A） of echocardiogram were observed，the levels of cTnT，CK-MB，N-terminal pro-brain natriuretic peptide （NT-proBNP） and inflammatory factor hypersensitivity C-reactive protein （hs-CRP）were determined in serum. Result：Compared with the pretreatment，the rate of arrhythmias increased，the difference was statistically after both chemotherapy treatment（P<0.05），the incidence of arrhythmia in the Tongmai Sini Decoction group was lower than that of the control group after chemotherapy，but there was no significantly difference （P>0.05）.The results of the heart function indexes（LVEF，LVEDD），the serum cTnT and CK-MB were not a significantly difference before and after therapy in two groups（P>0.05）.However E/A ratio，NT-proBNP level and hs-CRP in Tongmai Sini Decoction group were significantly better than the control group（P<0.05）.Conclusion：Tongmai Sini Decoction add and subtracton improvement of cardiac function and indicators of heart injury，among them， the increase of diastolic function index E/A ratio and the decrease of plasmaNT-proBNP level appeared earlier than the left cardiac function index（LVEF）and heart structural changes，which are better responsive to subclinical chemotherapy -induced

*基金项目：广东省中医药局科研课题立项项目（20172105）；

广东省医学科学技术研究基金项目（20161132121827）；广

州市医药卫生局科技项目（2016A011065）

①广州医科大学附属肿瘤医院　广东　广州　510095

通信作者：林云恩