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Received:September 11, 2023 Published Online:March 20, 2024
Received:September 11, 2023 Published Online:March 20, 2024
中文摘要: 目的 研究艾灸内关穴在预防乳腺癌含蒽环类药物化疗所致心肌损害中的作用，探索艾灸内关穴减轻化疗心脏毒性的可行性。方法 选取陕西省肿瘤医院乳腺科2020年5月至2021年5月收治的行EC-T（吡柔比星+环磷酰胺序贯多西他赛）方案术后辅助化疗的乳腺癌患者80例，依据随机数表法分为对照组40例和试验组40例。两组患者在前4周期化疗过程中，使用吡柔比星药物当天均同时使用右雷佐生；试验组患者于化疗前1天开始进行艾灸内关穴，每天2次，连续3 d。 观察两组患者4周期化疗前后的心电图、心功能、血肌钙蛋白I（cTnI）和N末端脑钠肽前体（NT-proBNP）水平，以及Karnofsky功能状态评分（KPS）的变化。结果 4周期化疗后，心律异常发生率［22.5%(9/40) vs 50.0%(20/40), χ2=6.545, P=0.010］和QRS波群电压下降发生率试验组均低于对照组［27.5%(11/40) vs 55.0%(22/40), χ2=6.241, P=0.012］。化疗后试验组心功能分级优于对照组（ Z=2.388，P=0.017）。4周期化疗后，对照组左心室射血分数（LVEF）下降、左室舒张末期内径（LVEDD）增大，试验组LVEF、LVEDD变化不明显，两组cTnI和NT-proBNP水平及KPS评分均升高，且试验组LVEF、LVEDD、 cTnI和NT-proBNP水平及KPS评分均优于对照组（P＜0.05）。结论 艾灸内关穴对于乳腺癌含蒽环类药物化疗所致心肌损害具有明显的保护作用，可以在右雷佐生作用的基础上进一步改善心肌功能。
Abstract:Objective To investigate the effect of moxibustion on Neiguan acupoint in preventing myocardial damage caused by anthracycline-based chemotherapy in breast cancer patients, and to explore the feasibility of moxibustion on Neiguan acupoint in reducing cardiotoxicity induced by chemotherapy. Methods A total of 80 breast cancer patients who underwent adjuvant chemotherapy with EC-T (pirarubicin + cyclophosphamide followed by docetaxel) regimen after surgery in the Department of Breast Cancer, Shaanxi Provincial Cancer Hospital from May 2020 to May 2021 were selected and divided into control group (n=40) and experimental group (n=40) randomly. During the first four cycles of chemotherapy, both groups received dexrazoxane on the same day as pirarubicin. The experimental group received moxibustion on Neiguan acupoint for three consecutive days starting one day before chemotherapy. The electrocardiograms, cardiac function, levels of cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), and Karnofsky Performance Status (KPS) score were observed before and after four cycles of chemotherapy. Results After four cycles of chemotherapy, the incidences of arrhythmia ［22.5%(9/40) vs 50.0%(20/40), χ2=6.545, P=0.011］ and QRS wave voltage decrease［27.5%(11/40) vs 55.0%(22/40), χ2=6.241, P=0.012］ in the experimental group were lower than those in the control group. The cardiac function classification in the experimental group was better than that in the control group ( Z=2.388，P＜0.017). After four cycles of chemotherapy, left ventricular ejection fraction (LVEF) decreased and left ventricular end-diastolic diameter (LVEDD) increased in the control group, while LVEF and LVEDD changes were not significant in the experimental group. The cTnI levels, NT-proBNP levels, and KPS scores increased in both groups, and LVEF, LVEDD, cTnI, NT-proBNP levels, and KPS scores were better in the experimental group than those in the control group (P＜0.05). Conclusion Moxibustion on Neiguan acupoint has a significant protective effect on myocardial damage caused by chemotherapy in breast cancer patients, and can further improve myocardial function on the basis of dexrazoxane.
keywords: Moxibustion Neiguan acupoint Breast cancer Chemotherapy Pirarubicin Dexrazoxane Myocardial damage Cardiac troponin Brain natriuretic peptide Cardiotoxicity
文章编号： 中图分类号：R737.9 R246.5 文献标志码：A
基金项目:陕西省重点研发计划项目（2021SF-218）
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