乳腺癌患者的心脏毒性:癌症治疗中hs -肌钙蛋白t变化与心功能的关系。

N V Dovganych, S M Kozhukhov, I I Smolanka, O F Lygyrda, O Ye Bazyka, S A Lyalkin, O M Ivankova, O A Yarynkina, N V Tkhor
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引用次数: 1

摘要

乳腺癌患者(BC)由于联合癌症治疗有很高的心脏毒性(CT)风险。心血管(CV)并发症导致BC治疗的延迟或停药,并使生存恶化。因此,在心功能障碍和心力衰竭(HF)体征出现之前的早期阶段检测CT是很重要的。目的:研究BC患者化疗和放疗(RT)期间高敏感(hs)肌钙蛋白(Tn) T (hs- tnt)水平的动态变化,以预测和预防个体化治疗过程中的CV并发症。材料和方法:40例BC患者纳入初步研究。分析肿瘤治疗前及治疗后6个月内左心室hs-TnT及射血分数(EF)的动态变化。在数据分析的基础上,提出了hs-TnT显著增加的定义。通过其基线水平与癌症治疗6个月之间的差异(%)来计算hs-TnT的上升。BC患者根据hs-TnT升高程度分为三组:1组低(0- 50%),2组中(> 50- 100%),3组高(> 100%)。结果:肿瘤治疗开始前,各组间LVEF无显著差异(平均EF(62.6±1.0)%),hs-TnT水平也在正常值(0.008±0.001 ng/ml)范围内。在6个月的癌症治疗中,LVEF在正常范围内,1组患者的LVEF无显著差异。2、3组患者LVEF下降幅度分别为5.7% (p < 0.01)和10.8% (p < 0.01)。相关性分析表明,hs-TnT升高百分比(δhs-TnT)与δEF LV (r = 0.39, r < 0.05)和蒽环类药物(AC)使用相关(r = 0.37, r < 0.05)。采用logistic回归和ROC分析,确定hs-TnT升高> 165%的诊断阈值,可作为早期生化CT的可靠标志物,敏感性为99%,特异性为56%。结论:在BC患者中,基于hs-TnT水平增高,提出了一种新的早期CT生化检测方法。在新方法下,hsTnT较基线增加> 165%的BC患者可被认为是早期生化CT的可靠标志物,敏感性为99%,特异性为56%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CARDIOTOXICITY IN BREAST CANCER PATIENTS: RELATIONSHIP OF HS-TROPONIN T CHANGES AND HEART FUNCTION IN CANCER TREATMENT.

Breast cancer patients (BC) have a high risk of cardiotoxicity (CT) due to a combination of cancer treatments.Cardiovascular (CV) complications lead to delay or withdrawal of BC therapy and worsen the survival. Therefore, it isimportant to detect CT at the early stages before the occurrence of cardiac dysfunction and heart failure (HF) signs.

Objective: to study the dynamic changes of high-sensitivity (hs) troponin (Tn) T (hs-TnT) level in BC patients during cancer treatment with the use of chemotherapy and radiation therapy (RT) to predict and prevent CV complications during individualized management.

Material and methods: 40 BC patients were included in the pilot study. The analysis of the dynamic changes of hs-TnT and ejection fraction (EF) of the left ventricle (LV) was performed before and within 6 months of cancer treatment. Based on the data analysis, a definition of a significant increase in hs-TnT was developed and proposed. Therise of hs-TnT was calculated by the difference (%) between its baseline level and in the 6 months of cancer treatment. BC patients are grouped into tertiles according to the hs-TnT increase: group 1 - low level (0-50 %), group 2 -moderate level (> 50-100 %), and group 3 - high level (> 100 %).

Results: Before the start of cancer treatment, LVEF did not differ significantly between groups (mean EF (62.6 ± 1.0) %)and the hs-TnT level was also within normal values (0.008±0.001 ng/ml). In 6 months of cancer treatment, LVEF waswithin the normal ranges and did not differ significantly in patients of group 1. However, in patients of groups 2and 3 - LVEF drop (δLV EF) was 5.7 % (р < 0.01) and 10.8 % (р < 0.01), consequently. According to the correlationanalysis, the percentage of increase in hs-TnT (δhs-TnT) was associated with δEF LV (r = 0.39, р < 0.05) and the useof anthracyclines (AC) (r = 0.37, р < 0.05). Using logistic regression and ROC analysis, the diagnostic threshold valueof the hs-TnT increase > 165 % was defined, which can be considered as a reliable marker of early biochemical CT,with a sensitivity of 99 % and a specificity of 56 %.

Conclusions: In BC patients, based on the level of hs-TnT increase, proposed a new early biochemical CT detectionmethod. Under the new approach, BC patients with hsTnT increase of > 165 % from baseline can be considered as areliable marker of early biochemical CT, with a sensitivity of 99 % and a specificity of 56 %.

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Problemy radiatsiinoi medytsyny ta radiobiolohii
Problemy radiatsiinoi medytsyny ta radiobiolohii Medicine-Radiology, Nuclear Medicine and Imaging
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