Hayakawa H, Komada Y, Hirayama M, Hori H, Ito M, Sakurai M
Department of Pediatrics, Mie University School of Medicine, Tsu, Mie, Japan.
Med Pediatr Oncol. 2001 Jul;37(1):4-9. doi: 10.1002/mpo.1155.
Anthracyclines are effective anticancer drugs for childhood cancer with dose-limiting cardiotoxicity. Children who have received anthracyclines thus need periodical cardiac evaluation. The plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) have been shown to increase in proportion to severity of cardiac dysfunction. We examined whether plasma levels of ANP and BNP, in addition to echocardiographic evaluation, can be used as specific markers for doxorubicin-induced cardiotoxic effects in children.
Consecutively, 34 patients (18 boys and 16 girls) who had previously received doxorubicin-containing chemotherapy were enrolled in this study. Plasma ANP and BNP were assayed simultaneously at the time of first cardiac function evaluation by echocardiography.
Of the 34 patients, 8 (23.5%) had left ventricular dysfunction as assessed by echocardiography. Both ANP and BNP plasma levels in these patients were significantly elevated in comparison with healthy controls (P < 0.01) or patients with normal cardiac function (P < 0.05). It should be also noted that ANP and BNP levels were correlated significantly with cardiac systolic function, but not with diastolic function.
These results suggest that plasma ANP and BNP levels could be markers for doxorubicin-induced cardiotoxicity in children. Measurement of natriuretic peptide levels during treatment may allow earlier-identification of individuals at risk for severe cardiac damage.
蒽环类药物是治疗儿童癌症的有效抗癌药物，但具有剂量限制性心脏毒性。因此，接受过蒽环类药物治疗的儿童需要定期进行心脏评估。已有研究表明，血浆心房利钠肽（ANP）和脑利钠肽（BNP）水平会随着心脏功能障碍的严重程度而升高。我们研究了除超声心动图评估外，血浆ANP和BNP水平是否可作为儿童阿霉素诱导的心脏毒性的特异性标志物。
本研究连续纳入了34例先前接受过含阿霉素化疗的患者（18例男孩和16例女孩）。在首次通过超声心动图评估心脏功能时，同时检测血浆ANP和BNP。
在这34例患者中，通过超声心动图评估发现8例（23.5%）存在左心室功能障碍。与健康对照组（P < 0.01）或心脏功能正常的患者（P < 0.05）相比，这些患者的血浆ANP和BNP水平均显著升高。还应注意的是，ANP和BNP水平与心脏收缩功能显著相关，但与舒张功能无关。
这些结果表明，血浆ANP和BNP水平可能是儿童阿霉素诱导的心脏毒性的标志物。在治疗期间测量利钠肽水平可能有助于更早识别有严重心脏损伤风险的个体。
