Department of Medicine, Division of Hematology/Oncology/Transplantation, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN 55455, USA.
Breast Cancer Res Treat. 2010 Jul;122(2):585-90. doi: 10.1007/s10549-009-0730-5. Epub 2010 Jan 8.
Doxorubicin (DOX), despite causing cardiac toxicity, is an anthracycline chemotherapeutic agent that plays an important role in the treatment of breast cancer. Angiotensin-converting enzyme inhibitors (ACE-I) may protect against cardiac toxicity in patients receiving DOX chemotherapy. A total of 143 patients receiving DOX at the Masonic Comprehensive Cancer Clinic, University of Minnesota, who had two or more multigated blood pool imaging (MUGA) scans or echocardiograms performed between 2004 and 2007 were identified and reviewed. Patients with a 10% absolute drop in their ejection fraction (EF) or more to below 55% were identified and compared with those that did not have a 10% decline in EF. Impact of patient variables and the use of concurrent medications on EF drop were evaluated using logistic regression. Median age was 52 years old. 85 (60%) were female. Cancer diagnosis was breast (n = 26), lymphoma (n = 92), and other (n = 25). In spite of a similar baseline EF in all the patients, 22/142 (15%) patients had a significant drop in EF during DOX chemotherapy. Adjusting for age, the odds ratio of EF drop associated with the use of ACE-I is 0.267 (P = 0.0940), suggesting that ACE-I has a protective effect. Cumulative DOX dose, the use of beta-blockers, or aspirin did not appear to be predictive or protective. Although not statistically significant, this study suggests that the use of ACE-I when given with DOX chemotherapy protects against DOX chemotherapy and warrants further investigation.
多柔比星（DOX）虽然会引起心脏毒性，但它是一种蒽环类化疗药物，在乳腺癌的治疗中发挥着重要作用。血管紧张素转换酶抑制剂（ACE-I）可能会预防接受 DOX 化疗的患者的心脏毒性。在明尼苏达大学梅森综合癌症诊所接受 DOX 治疗的 143 名患者中，有 2 名或 2 名以上的多门控血池成像（MUGA）扫描或超声心动图在 2004 年至 2007 年之间进行了检查。筛选出 EF 绝对下降 10%以上且低于 55%的患者，并与 EF 没有下降 10%的患者进行比较。使用逻辑回归评估患者变量和同时使用药物对 EF 下降的影响。中位年龄为 52 岁。85 名（60%）为女性。癌症诊断为乳腺癌（n=26）、淋巴瘤（n=92）和其他（n=25）。尽管所有患者的基线 EF 相似，但 22/142 名（15%）患者在 DOX 化疗期间 EF 显著下降。调整年龄后，EF 下降与 ACE-I 使用相关的比值比为 0.267（P=0.0940），表明 ACE-I 具有保护作用。DOX 累积剂量、β受体阻滞剂或阿司匹林的使用似乎没有预测或保护作用。尽管没有统计学意义，但这项研究表明，在接受 DOX 化疗时使用 ACE-I 可预防 DOX 化疗，值得进一步研究。
