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中华乳腺病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (05) : 282 -286. doi: 10.3877/cma.j.issn.1674-0807.2017.05.006

所属专题: 经典病例

论著

使用曲妥珠单克隆抗体后发生心脏瓣膜返流的HER-2 阳性乳腺癌25 例临床观察
曾化桂1, 田璨2, 刘莉萍2, 谢宁2, 唐石初3, 欧阳取长2,()   
  1. 1.410219 长沙医学院附属第一医院肿瘤科
    2.410013 长沙,湖南省肿瘤医院乳腺内科
    3.410013 长沙,湖南省肿瘤医院超声诊断中心
  • 收稿日期:2017-04-13 出版日期:2017-10-01
  • 通信作者: 欧阳取长

Heart valve regurgitation in HER-2 positive breast cancer patients treated with trastuzumab:25 cases

Huagui Zeng1, Can Tian2, Liping Liu2, Ning Xie2, Shichu Tang3, Quchang Ouyang2,()   

  1. 1.Department of Oncology, First Affiliated Hospital,Changsha Medical University, Changsha 410219, China
    2.Department of Breast Internal Medicine, Hunan Cancer Hospital, Changsha 410013, China
    3.Department of Ultrasound, Hunan Cancer Hospital, Changsha 410013, China
  • Received:2017-04-13 Published:2017-10-01
  • Corresponding author: Quchang Ouyang
引用本文:

曾化桂, 田璨, 刘莉萍, 谢宁, 唐石初, 欧阳取长. 使用曲妥珠单克隆抗体后发生心脏瓣膜返流的HER-2 阳性乳腺癌25 例临床观察[J/OL]. 中华乳腺病杂志(电子版), 2017, 11(05): 282-286.

Huagui Zeng, Can Tian, Liping Liu, Ning Xie, Shichu Tang, Quchang Ouyang. Heart valve regurgitation in HER-2 positive breast cancer patients treated with trastuzumab:25 cases[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2017, 11(05): 282-286.

目的

探讨HER-2 阳性乳腺癌患者使用曲妥珠单克隆抗体后心脏瓣膜返流的发生情况。

方法

回顾性分析2010 年11 月至2014 年11 月湖南省肿瘤医院收治的HER-2 阳性并使用曲妥珠单克隆抗体治疗的乳腺癌患者338 例,用心脏彩色超声观察曲妥珠单克隆抗体治疗前后心脏瓣膜返流的发生情况。

结果

随访时间8 ~54 个月, 中位随访时间12 个月。 338 例患者中,25 例患者因使用曲妥珠单克隆抗体而发生了心脏瓣膜返流,心脏瓣膜返流的发生率为7.4%。 在25 例患者中,单纯二尖瓣返流者11 例(占44%),单纯三尖瓣返流者2 例(占8%),单纯主动脉瓣返流者1 例(占4%),单纯肺动脉瓣返流者1 例(占4%),合并二尖瓣、三尖瓣返流者6 例(占24%),合并三尖瓣、肺动脉瓣返流者1 例(占4%),合并二尖瓣、三尖瓣及肺动脉瓣返流者3 例(占12%)。 25 例患者治疗前左室射血分数(LVEF)为(72.2±6.5)%,首次瓣膜返流后LVEF 为(70.6±6.0)%。 20 例二尖瓣返流患者的左室内径和左房内径在治疗前分别为(44.2±2.8) mm、(27.0±2.9) mm,首次发生二尖瓣返流时分别为(45.1±4.5) mm、(27.4±2.7) mm。 随访期间心脏瓣膜返流总恢复率为36%(9/25)。

结论

HER-2 阳性乳腺癌患者在曲妥珠单克隆抗体治疗后可能发生心脏瓣膜返流,以二尖瓣、三尖瓣返流为主。

Objective

To investigate the incidence of heart valve regurgitation in patients with HER-2 positive breast cancer after trastuzumab administration.

Methods

A retrospective study was conducted on 338 HER-2 positive breast cancer patients treated with trastuzumab from November 2010 to November 2014. The occurrence of heart valve regurgitation was analyzed after trastuzumab administration. The color Doppler ultrasound of the heart was used to observe the occurrence of heart valve regurgitation before and after trastuzumab treatment.

Results

All patients were followed up for 8.0-54.0 months, median 12.0 months.Among all 338 patients, heart valve regurgitation occurred in 25 patients after trastuzumab treatment, with the incidence of 7.4%. Among those 25 patients,11 (44%) had simple mitral regurgitation,2 (8%) had simple tricuspid regurgitation, 1 (4%) had simple aortic regurgitation, 1 (4%) had simple pulmonary artery regurgitation,6 cases (24%) had mitral and tricuspid regurgitation, 1 case (4%) had mitral regurgitation combined with pulmonary valve regurgitation, and 3 cases (12%) had regurgitation in mitral, tricuspid and pulmonary valves. The left ventricular ejection fraction (LVEF) in 25 patients was (72.2±6.5)% before trastuzumab treatment and (70.6±6.0)% in the first valve regurgitation. For all 20 patients with mitral regurgitation, the left ventricular diameter and the left atrial diameter was (44.2±2.8) mm and (27.0 ± 2.9)mm before trastuzumab treatment, (45.1±4.5) mm and (27.4±2.7) mm in the first valve regurgitation. The total recovery rate of heart valve regurgitation during follow-up was 36% (9/25).

Conclusion

HER-2 positive breast cancer patients are in risk of heart valve regurgitation after trastuzumab treatment and most of the complications are mitral and tricuspid regurgitations.

表1 25 例发生心脏瓣膜返流的乳腺癌患者的临床病理特征
图1 乳腺癌患者曲妥珠单克隆抗体治疗引发心脏瓣膜返流前后的超声心动图
表2 25 例乳腺癌患者使用曲妥珠单克隆抗体后心脏瓣膜返流的发生部位
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