Dab tsi yog qhov kev mob tshwm sim ntev ntev ntawm Adriamycin?

Teb chaws

los ntawm tshuaj.com

Cov kev mob tshwm sim ntev tshaj plaws uas cuam tshuam nrog Adriamycin suav nrog:

    Cardiotoxicity Mob qog noj ntshav thib ob Amenorrheahauv cov poj niam laus dua 40 xyoo Teeb meem plab hnyuv Neurological teeb meem.

Adriamycin (doxorubicin) yog cov tshuaj kho mob qog noj ntshav uas tau siv ua tiav hauv kev tswj hwm ntawm ntau yam qog noj ntshav xws li mob qog noj ntshav qog ntshav, mob myeloblastic leukemia, Wilm's qog, lub mis thiab zes qe menyuam carcinomas, thiab ntau lwm yam qog noj ntshav. Nws yog nyob rau hauv chav kawm ntawm cov tshuaj hu ua anthracycline tshuaj tua kab mob.



Cov kev mob tshwm sim ntev tshaj plaws uas cuam tshuam nrog Adriamycin suav nrog:

  • Cardiotoxicity
  • Mob qog noj ntshav thib ob
  • Amerohhea hauv cov poj niam laus dua 40
  • Teeb meem plab hnyuv
  • Neurological teeb meem.

Cardiotoxicity

Cardiotoxicity yog ib qho kev mob tshwm sim ntev ntev ntawm Adriamycin. Cardiotoxicity txhais tau tias kev puas tsuaj mus tas li rau cov leeg ntawm lub plawv lossis kev ua haujlwm ntawm lub plawv.

qhov siab tshaj plaws ntawm ativan hauv 24 teev

Cardiotoxicity tuaj yeem ua rau mob hnyav nrog kev kho Adriamycin thiab tuaj yeem tshwm sim lig thaum kho, lossis hauv ob mus rau peb lub hlis tom qab kev kho mob tas. Cov tsos mob muaj xws li cov cim qhia lossis cov tsos mob ntawm lub plawv tsis ua haujlwm, suav nrog kev txo qis ntawm sab laug ntawm lub plawv mus rau twj tso kua mis (hu ua LVEF lossis sab laug ventricular ejection feem). Lub plawv dhia ceev, ua tsis taus pa luv, kua dej ntawm lub ntsws, nrog rau lwm yam tsos mob.

Qhov tshwm sim ntawm kev txhim kho cardiotoxicity nce siab dua cov koob tshuaj Adriamycin uas tau muab, piv txwv li, qhov tshwm sim yog:

  • 1-2% rau tag nrho cov koob tshuaj ntawm 300 mg / mobAdriamycin
  • 3-5% rau tag nrho cov koob tshuaj ntawm 400 mg / mobAdriamycin
  • 5-8% rau tag nrho cov koob tshuaj ntawm 450 mg / mobAdriamycin
  • 6-20% rau tag nrho cov koob tshuaj ntawm 500 mg / mobAdriamycin.

Qhov tshwm sim ntawm kev txhim kho lub plawv tsis ua haujlwm tau raug tshaj tawm raws li:

  • 1.5% rau ib koob tshuaj ntawm 300 mg / mobAdriamycin
  • 3-4.9% rau ib koob tshuaj ntawm 400-430 mg / mobAdriamycin
  • 7-7.7% rau ib koob tshuaj ntawm 450-475 mg / mobAdriamycin
  • 20.5-21% rau ib koob tshuaj ntawm 500-728 mg / mobAdriamycin.

Qhov kev pheej hmoo ntawm kev tsim lub plawv tsis ua haujlwm sai sai nrog kev nce koob tshuaj ntau dua 400 mg / mobthiab thaum Adriamycin siv nrog lwm cov tshuaj tua kab mob, xws li cyclophosphamide, fluorouracil, lossis vincristine.

Cardiotoxicity kuj tseem tuaj yeem tshwm sim ntawm cov koob tshuaj qis dua hauv cov neeg laus, cov neeg raug Adriamycin thaum tseem hluas, kev siv lwm cov tshuaj cardiotoxic, calcium channel blockers, kab mob hauv lub plawv ua ntej, lossis kev kho hluav taws xob ua ntej rau lub plawv. Cov neeg tau sau cov tshuaj monoclonal antibody trastuzumab muaj kev pheej hmoo siab dua ntawm cardiotoxicity nrog Adriamycin ntawm cov koob tshuaj qis dua.

Cov pob ntxig rau Adriamycin hais tias lub neej kev noj tshuaj ntau dua 550 mg / m2 (21-hnub mus ncig) cuam tshuam nrog kev pheej hmoo ntawm cardiomyopathy.

Hauv cov neeg uas muaj kev pheej hmoo siab ntawm cardiotoxicity, qhov siab tshaj plaws ntawm cov tshuaj doxorubicin yuav tsum raug txwv kom tsawg dua 400. Hauv qee kis, cov neeg tau txais tag nrho cov koob tshuaj ntawm 450 mg / m.obTej zaum yuav raug txiav txim siab rau kev kho ntxiv mus txog rau tag nrho cov koob tshuaj ntawm 700 mg / mobyog tias lawv tau txais kev ntsuam xyuas mob plawv thiab pom tau tias tsim nyog rau kev kho mob ntxiv.

Dexrazoxane tuaj yeem siv rau cardioprotection hauv cov neeg mob uas muaj mob qog noj ntshav lossis mob qog noj ntshav uas muaj kev pheej hmoo ntawm kev mob plawv thaum tau txais Adriamycin.

Mob qog noj ntshav thib ob

Ntau yam kev kho mob qog noj ntshav thiab kev kho hluav taws xob muaj feem cuam tshuam nrog kev mob qog noj ntshav theem nrab. Cov no yog cov qog nqaij hlav uas tshwm sim ntau xyoo tom qab kev kho mob qog noj ntshav thawj zaug, thiab tej zaum yuav cuam tshuam nrog kev kho mob uas siv, tsis yog cov qog nqaij hlav loj.

Adriamycin tau cuam tshuam nrog qhov tshwm sim ntawm tus mob myelogenous leukemia thiab myelodysplastic syndrome. Leukemia tuaj yeem cuam tshuam 2 txog 12% ntawm cov neeg uas tau kho nrog Adriamycin thiab feem ntau tshwm sim hauv ib mus rau peb xyoos ntawm kev kho mob. Nws feem ntau cuam tshuam nrog kev hloov pauv ntawm MLL noob ntawm chromosome band 11q23. Nws muaj ntau dua rau cov neeg mob hluas tab sis nws tsis paub tias cov neeg mob twg muaj kev pheej hmoo ntau dua, txawm hais tias kev siv cov tshuaj alkylating ib txhij (xws li cyclophosphamide, cisplatin, thiab chlorambucil) lossis kev kho hluav taws xob ua rau muaj kev pheej hmoo siab.

cov kev mob tshwm sim ntawm metoprolol

Kev coj khaub ncaws hloov

96% ntawm cov poj niam hnub nyoog 40 mus rau 49 xyoo tau sau tshuaj Adriamycin tsim amenorrhea (tsis muaj poj niam los ntshav).

Qhov no yog qhov ruaj khov rau cov poj niam feem ntau tshaj 40 xyoo. Hauv cov hnub nyoog qis dua 30 xyoo, tsis muaj kev coj khaub ncaws txawv txav, thiab rau cov neeg muaj hnub nyoog 30 txog 40 xyoo uas muaj amenorrhea, 50% tau rov qab mus rau lawv lub sijhawm ib txwm muaj thaum kho tiav.

plab hnyuv

Kev mob plab ntev ntev uas tau tshaj tawm nrog Adriamycin suav nrog:

  • Gastric ulcers los yog erosions
  • Hyperpigmentation ntawm tus nplaig lossis qhov ncauj mucosa (tsis tshua muaj)
  • ulceration thiab necrosis ntawm txoj hnyuv, tshwj xeeb tshaj yog cecum (tsis tshua muaj).

Neurological

Adriamycin tau cuam tshuam nrog ntau qhov kev mob tshwm sim mus sij hawm ntev, xws li:

  • Peripheral neuropathy: Qhov no yog kev puas tsuaj rau cov hlab ntsha uas nqa cov lus los ntawm lub hlwb thiab tus txha caj qaum mus rau tag nrho lub cev. Cov tsos mob tuaj yeem suav nrog txhais tes thiab ko taw txias, tsis zoo li ko taw ncig, pins thiab koob, loog, muaj kev pheej hmoo kis mob thiab raug mob.
  • Cov leeg tsis muaj zog
  • Kev paub hloov pauv: Feem ntau piav raws li chemo pos huab. Cov no yuav ua rau muaj teeb meem nrog kev ua haujlwm ntau, kev xav, lossis mob taub hau. Hauv cov neeg feem ntau cov no yog ib ntus; Txawm li cas los xij, lawv tuaj yeem mob siab rau qee tus neeg.
Cov ntaub ntawv

Cov Lus Nug Txog Kev Kho Mob

Cov Ntaub Ntawv Tshuaj

Cov pab pawg txhawb nqa ntsig txog