摘要
目的探讨Ⅳ期非小细胞肺癌(NSCLC)表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)靶向治疗与放疗同步应用时心血管毒性的检测手段。方法选取2017年至2019年行放疗的70例Ⅳ期NSCLC患者,随机分为放疗组和联合治疗组,每组35例。放疗总剂量48~66 Gy、常规分割;靶向药物包括吉非替尼、吉非替尼片、埃克替尼、和阿法替尼;联合治疗组靶向药物自放疗第1天同步开始。2组患者均于放疗前1周、放疗第2天、放疗第30天及放疗结束后1个月行常规心电图、超声心动图、cTn及NT-proBNP的数据采集。结果急性心脏损伤者2组共26例,发生率37.14%,2组患者比较差异无统计学意义(P=0.62),所有心脏损伤患者均表现为1级。常规心电图以心率及Q-T间期为观察指标,组内及组间比较差异无统计学意义(P>0.05)。超声心动图以左心室短轴收缩率、左心室射血分数、二尖瓣口E/A比值、左心室Tei指数为观察指标,左心室射血分数组内比较有统计学意义(P<0.05)、组间比较接近统计学意义(P=0.05),左心室Tei指数组内、组间比较均有统计学意义(P<0.05),余指标差异无统计学意义(P>0.05)。cTn、NT-proBNP检测数值组内、组间比较均有统计学差异(P<0.05),cTnI较NT-proBNP差异更显著,cTnI以放疗结束1个月升高最明显,NT-proBNP以放疗第2天升高最明显。结论EGFR-TKI靶向治疗同步放疗在Ⅳ期NSCLC的应用中,心血管损害具有叠加效应,但并不十分显著;Ⅳ期NSCLC的EGFR-TKI靶向治疗同步放疗相关心血管毒性检测方法中,常规心电图不敏感,超声心动图的LVEF、左心室Tei指数及血清学指标cTnI、NT-proBNP显示出较好优势。
Objective To investigate the detection method of cardiovascular toxicity in patients with phaseⅣnon-small cell lung cancer(NSCLC)treated by EGFR-TKI targeted therapy combined with concurrent radiotherapy(RT).Methods A total of 70 patients with stageⅣNSCLC who underwent RT in our hospital from 2017 to 2019 were enrolled in the study,who were divided into RT group and combined treatment group,with 35 patients in each group.The total dose of RT was 48-66Gy with conventional fractionated,and the targeted drugs included gefitinib,gefitinib tablets,ectinib and afatinib.The targeted drugs started synchronously from the day 1 of RT.And ECG,echocardiography,and the detection of cTnI and NT-proBNP were performed at 1 week before RT,at 2 days and 30 days after RT,1month at the end of RT.Results There were 26 cases of acute cardiac damage in the two groups,with the incidence rate being 37.14%,there was no significant differences between the two groups(P>0.05).There was no significant differences in heart rate(HR)and Q-T interval detected by ECG in intragroup comparison and group comparison(P>0.05).However there were significant differences in echocardiography examination indexes including left ventricular fractional shortening(LVFS),left ventricular ejection fraction(LVEF),mitral valve E/A ratio(E/A)and left ventricular Tei index(Tei)in intragroup comparison(P<0.05),and there were significant differences in LVEF levels in group comparison(P<0.05).There were statistically significant differences in the cTnI and NT-proBNP detection values in intragroup comparison and group comparison(P<0.05).The difference of cTnI was more significant than that of NT-proBNP.Conclusion In the application of EGFR-TKI targeted therapy and concurrent RT in stageⅣNSCLC,the cardiovascular injury has a superposition effect,but it is not very significant.In the detection method of cardiovascular toxicity in patients with phaseⅣNSCLC treated by EGFR-TKI targeted therapy combined with RT,the ECG is not sensitive,and the echocardiographic LVEF,le
作者
李锦秋
张志林
杜炜
席强
赵春桃
卢秀荣
LI Jinqiu;ZHANG Zhilin;DU Wei(Department of Radiotherapy,The First Hospital Affiliated to Hebei North College,Hebei,Zhangjiakou 075000,China)
出处
《河北医药》
CAS
2020年第17期2589-2593,共5页
Hebei Medical Journal
基金
河北省医学科学研究重点课题计划项目(编号:20150477)。
