2024 年第 11 期 第 19 卷

血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂类药物治疗贝伐珠单抗所致心血管毒性的效果及影响因素

The efficacy and influencing factors of angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker drugs in the treatment of cardiovascular toxicity induced by bevacizumab

作者：王娟秦明强张卉

英文作者：Wang Juan Qin Mingqiang Zhang Hui

单位：南京中医药大学第二附属医院江苏省第二中医院药学部，南京210000

英文单位：Department of Pharmacy the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine Jiangsu Second Hospital of Traditional Chinese Medicine Nanjing 210000 China

关键词：心血管毒性；贝伐珠单抗；血管紧张素Ⅱ受体拮抗剂；血管紧张素转换酶抑制剂

英文关键词：Cardiovasculartoxicity;Bevacizumab;AngiotensinⅡreceptorblocker;Angiotensinconvertingenzymeinhibitor

• 摘要：

• 目的 探究血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）类药物治疗贝伐珠单抗所致心血管毒性效果的影响因素，为临床提高抗心血管毒性效果提供参考。方法 选取2021年1月至2023年12月江苏省第二中医院128例贝伐珠单抗治疗后发生心血管毒性的肿瘤患者，根据是否采取ACEI/ARB类药物治疗分为2组，将采取ACEI/ARB类药物治疗的95例患者纳入观察组，将未采取ACEI/ARB类药物治疗的33例患者纳入对照组。比较2组心肌肌钙蛋白I（cTnI）、N末端B型脑钠肽前体（NT-proBNP）、左心室射血分数（LVEF）、收缩压、舒张压水平。采用单因素、多因素分析ACEI/ARB类药物治疗贝伐珠单抗引起心血管毒性效果的影响因素。结果 观察组患者血浆NT-proBNP、cTnI水平、收缩压、舒张压均低于对照组，LVEF高于对照组（均P＜0.05）。ACEI/ARB类药物治疗心血管毒性的临床效果评估中治愈60例（63.2%），好转30例（31.6%），无效5例（5.3%）。临床分期（比值比=5.349）、合并心血管疾病（比值比=3.132）、心脏毒性反应分级（比值比=4.218）、血浆NT-proBNP（比值比=2.824）、血浆cTnI（比值比=3.779）水平是ACEI/ARB类药物治疗心血管毒性效果的危险因素，LVEF水平（比值比=0.333）是ACEI/ARB类药物治疗心血管毒性效果的保护因素（均P＜0.05）。结论 ACEI/ARB类药物治疗贝伐珠单抗所致心血管毒性具有一定效果，可降低心血管毒性，减轻心肌损伤。临床分期、合并心血管疾病、心脏毒性反应分级、血浆NT-proBNP、血浆cTnI为ACEI/ARB类药物治疗效果的危险因素，LVEF水平为治疗效果的保护因素。

• Objective To explore the efficacy and influencing factors of angiotensin converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blocker (ARB) drugs in the treatment of cardiovascular toxicity induced by bevacizumab, so as to provide reference for clinical improvement of anti-cardiovascular toxicity. Methods A total of 128 cancer patients with cardiovascular toxicity after bevacizumab treatment in Jiangsu Second Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were selected. Patients were divided into two groups according to whether they were treated with ACEI/ARB drugs, 95 patients who took ACEI/ARB drugs were included in the observation group, and 33 patients who did not take ACEI/ARB drugs were included in the control group.The levels of cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), systolic blood pressure and diastolic blood pressure were compared between the two groups. Univariate and multivariate analysis were used to analyze the influencing factors of cardiovascular toxicity caused by ACEI/ARB drugs in the treatment of bevacizumab. Results The levels of NT-proBNP, cTnI, systolic blood pressure and diastolic blood pressure in the observation group were lower than those in the control group, and the LVEF was higher than that in the control group (all P＜0.05).In the clinical effect evaluation of ACEI/ARB drugs in the treatment of cardiovascular toxicity, 60 cases (63.2%) were cured, 30 cases (31.6%) were improved and 5 cases (5.3%) were ineffective. Clinical staging (odds ratio=5.349), concomitant cardiovascular disease (odds ratio=3.132), cardiac toxicity grade (odds ratio=4.218), plasma NT-proBNP (odds ratio=2.824), and plasma cTnI (odds ratio=3.779) levels were risk factors for cardiovascular toxicity effects of ACEI/ARB drug therapy, while LVEF level (odds ratio=0.333) was a protective factor for cardiovascular toxicity effects of ACEI/ARB drug therapy (all P＜0.05). Conclusion ACEI/ARB drugs have a certain effect in the treatment of cardiovascular toxicity induced by bevacizumab, which can reduce cardiovascular toxicity and myocardial injury. The risk factors for ACEI/ARB treatment included clinical stage, cardiovascular disease, cardiotoxicity grade, NT-proBNP and cTnI, while LVEF was a protective factor.