Bristow M R, Thompson P D, Martin R P, Mason J W, Billingham M E, Harrison D C
Am J Med. 1978 Nov;65(5):823-32. doi: 10.1016/0002-9343(78)90802-1.
Eight patients in whom cardiac dysfunction developed within four weeks of receiving their first or second course of daunorubicin or doxorubicin are described. Four patients presented with pericarditis; three of these four had evidence of myocardial dysfunction. Histopathologic analysis of these patients was consistent with an acute myocyte damage and secondary inflammatory process. An additional group of four patients presented with symptoms and signs of heart failure. These patients were either elderly or had evidence of previous cardiac disease. One of these patients suffered a myocardial infarction 24 hours after receiving 60 mg/m2 of daunorubicin; earlier doses in the same course had been associated with evidence of myocardial ischemia. We conclude that anthracycline antibiotics may manifest clinically significant cardiotoxicity at total cumulative doses much less than have been associated with chronic cardiomyopathy.
本文描述了8例在接受第一疗程或第二疗程柔红霉素或阿霉素治疗后四周内出现心脏功能障碍的患者。4例患者表现为心包炎，其中3例有心肌功能障碍的证据。对这些患者的组织病理学分析与急性心肌细胞损伤和继发性炎症过程一致。另外4例患者出现心力衰竭的症状和体征。这些患者要么是老年人，要么有既往心脏病的证据。其中1例患者在接受60mg/m²柔红霉素治疗24小时后发生心肌梗死；同一疗程中较早剂量已出现心肌缺血的证据。我们得出结论，蒽环类抗生素在总累积剂量远低于与慢性心肌病相关的剂量时，可能表现出具有临床意义的心脏毒性。
