#1
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êàðäèîòîêñè÷íîñòü àíòðàöèêëèíîâ
Óâàæàåìûå äîêòîðà, õîòåëîñü áû óçíàòü âàøå ìíåíèå ïî ñëåäóþùåìó âîïðîñó.
Êàê çàùèòèòü ìèîêàðä ïðè ëå÷åíèè ïàöèåíòîâ êàðäèîòîêñè÷íûìè ïðîòèâîîïóõîëåâûìè ïðåïàðàòàìè (íàïðèìåð, äîêñîðóáèöèíîì)? Êàê âû îòíîñèòåñü ê òàêèì êàðäèîïðîòåêòîðàì, êàê êàðäèîêñàí? Íàäî ëè åãî íàçíà÷àòü âñåì ïàöèåíòàì, ïîëó÷àþùèì ïðîòèâîîïóõîëåâûå ïðåïàðàòû èëè òîëüêî ïàöèåíòàì ñ êëèíèêîé ÑÑÇ (âêëþ÷àÿ ñþäà òàêæå ëèö, èìåþùèõ ëèøü ôóíêöèîíàëüíûå èçìåíåíèÿ, âûÿâëÿåìûå èíñòðóìåíòàëüíî (íàïðèìåð, íà ÝÕÎÊÃ)?) Çíàåòå ëè âû åù¸ êàêèå-íèáóäü ïðåïàðàòû èëè ìåòîäû ïðîôèëàêòèêè èëè ëå÷åíèÿ ïîñëåäñòâèé êàðäèîòîêñè÷íîñòè ïðîòèâîîïóõîëåâûõ ïðåïàðàòîâ? Ñïàñèáî |
#2
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Òîëüêî ïðî êàðäèîêñàí è çíàþ...
Ýâèäåíñà âðîäå áû íå áîëüíî ìíîãî. Åñëè áû äîñòàòü âîò ýòîò îáçîð÷èê, íàâåðíî ÷òî-íèáóäü ïðîÿñíèëîñü áû. Expert Rev Cardiovasc Ther. 2008 Nov;6(10):1311-7. Links Utility of dexrazoxane for the reduction of anthracycline-induced cardiotoxicity. Jones RL. Sarcoma and Drug Development Units, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Dexrazoxane is a derivative of the powerful metal-chelating agent ethyl enediamine tetra acetic acid. Its cardioprotective effect is thought to be due to its ability to chelate iron and reduce the number of metal ions complexed with anthracycline and, consequently, decrease the formation of superoxide radicals. Preclinical studies have confirmed that dexrazoxane has significant activity as a cardioprotective agent against anthracycline-induced cardiotoxicity. Dexrazoxane is well-tolerated, with myelosuppression being the dose-limiting toxicity in Phase I trials. The cardioprotective utility of dexrazoxane has been further illustrated in a number of randomized trials. In addition no significant difference in survival has been observed between the dexrazoxane and control arms of these trials but, in one, a significantly lower response rate was observed in the dexrazoxane compared to placebo arm. Further trials are required to evaluate the efficacy of dexrazoxane in hematological malignancies as well as the adjuvant treatment of breast cancer. Its use in the paediatric setting and in the management of elderly patients with cardiac comorbidity also requires investigation. Recently, interest has focused on the use of dexrazoxane as an antidote for anthracycline extravasation. In addition the general cytoprotective activity of this drug requires further assessment, as well as selectivity in this context. |
#3
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Íå ýâàéäåíñ, íî ïîñëåäñòâèÿ êàðäèîòîêñè÷íîñòè ïðîòèâîîïóõîëåâûõ ñðåäñòâ â íåêîòîðûõ îíêîëîãè÷åñêèõ öåíòðàõ óñòðàíÿëè ñ ïîìîùüþ äèãîêñèíà. Íà ôîíå ïðèìåíåíèÿ íèçêèõ äîç äèãîêñèíà íàáëþäàëîñü ñîêðàùåíèå ïîëîñòåé ïðè òîêñè÷åñêîé ÄÊÌÏ. Âîîáùå æå èññëåäîâàíèé ïî ýòîé òåìå â ïðèíöèïå ìàëî.
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#4
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Óâàæàåìûå êîëëåãè, äëÿ ìåíÿ ýòîò âîïðîñ òîæå ñòàë àêòóàëüíûì.
Îáðàòèëàñü ïàöèåíòêà òðèäöàòè ñ íåáîëüøèì ëåò, ïîñëå âòîãî êóðñà ÏÕÒ (âêëþ÷àÿ äîêñîðóáèöèí) ïî ïîâîäó cancer ìîëî÷íîé æåëåçû. Æàëîáû íà áîëè â îáëàñòè ñåðäöà, ñåðäå÷íîé íåäîñòàòî÷íîñòè íåò. Âåðí¸òñÿ êî ìíå ïîñëå ÝÕÎ è áèîõèìèè. Ìíå íóæíî áóäåò çà îäèí ïðèåì óâèäåòü ðåçóëüòàòû è äàòü ðåêîìåíäàöèè, ïîýòîìó íå ïðèâîæó ðåçóëüòàòîâ îáñëåäîâàíèÿ. Òåîðåòè÷åñêè â êàêîé ñèòóàöèè äëÿ íå¸ áóäåò àêòóàëåí êàðäèîêñàí (ïðè ïîâûøåíèè ìàðêåðîâ íåêðîçà ìèîêàðäà, ïðè îòêëîíåíèé îò íîðìû êàðäèîìåòðèè è ñèñòîëè÷åñêîé/äèàñòîëè÷åñêîé äèñôóíêöèè èëè ïðè íîðìàëüíûõ ðåçóëüòàòàõ îáñëåäîâàíèÿ êàðäèîêñàí åé òîæå áóäåò ïîêàçàí?)? Êàêîâ âàø îïûò èëè ñëîæèâøååñÿ ìíåíèå ïî ýòîìó âîïðîñó? Åñòü ëè àëüòåðíàòèâà êàðäèîêñàíó? Äîáàâëþ, ÷òî áûëà òðàíçèòîðíàÿ ëåéêîïåíèÿ, àíåìèÿ ïîñëå ÏÕÒ (ïîêàçàòåëè ïîâûñèëèñü íà ôîíå ëå÷åíèÿ) - ýòî êàê-áóäòî íåæåëàòåëüíî äëÿ íàçíà÷åíèÿ êàðäèîêñàíà... |
#5
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#6
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#7
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Íàñêîëüêî ÿ ïîíÿë, ïîêàçàíèåì ê êàðäèîêñàíó ÿâëÿåòñÿ ïðèåì ïðîòèâîîïóõîëåâûõ ïðåïàðàòîâ äëÿ ïðåäóïðåæäåíèÿ òîêñè÷åñêîãî ýôôåêòà, à íå ëå÷åíèå óæå ðàçâèâøåéñÿ êàðäèîïàòèè ïîñëå îêîí÷àíèÿ êóðñà õèìèîòåðàïèè.
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#8
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àíåìèÿ ëåãêîé ñòåïåíè (ãåìîãëîáèí 105-110) íà ñåãîäíÿøíèé äåíü. Áîëè ïîÿâèëèñü ïîñëå âòîðîãî êóðñà ÏÕÒ íà ôîíå ýòèõ öèôð.
Äà. Äëÿ ïðîôèëàêòèêè âðîäå áû. Ðåøàåòñÿ âîïðîñ î ïîâòîðíûõ êóðñàõ ÏÕÒ, áóäóò åùå îïåðàòèâíûå âìåøàòåëüñòâà (ïîêà íå áûëî ìàñòýêòîìèè, òîëüêî ðåçåêöèÿ íåî è ðåãèîíàðíûõ ë/óçëîâ) - ëå÷åíèå íå çàêîí÷åíî. Åñëè îáíàðóæèì èçìåíåíèÿ íà ÝÕÎ - êàêîâà òàêòèêà (íàïîìíþ, ïðèçíàêîâ ÑÍ íåò, ÿâíûõ ïðîòèâîïîêàçàíèé ê ÏÕÒ íåò)? Åñëè êàðäèîìåòðèÿ è ôóíêöèÿ â ïîðÿäêå - íàçíà÷àåì äëÿ ïðîôèëàêòèêè êàðäèîêñàí ïðè ïîâòîðíûõ êóðñàõ ÏÕÒ? |
#9
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Áîëåâîé ñèíäðîì ì.á. îáóñëîâëåí îñòðîé êàðäèîòîêñè÷íîñòüþ äîêñîðóáèöèíà, êëèíè÷åñêè ïðîÿâëÿåòñÿ êàê ìèîïåðèêàðäèò: áîëåâîé ñèíäðîì, èçìåíåíèÿ íà ÝÊÃ, àðèòìèè, ïîâûøåíèå êàðäèîìàðêåðîâ, íåáîëüøîé âûïîò â ïîëîñòè ïåðèêàðäà, ñíèæåíèå ãëîáàëüíîé ñîêðàòèìîñòè, íàðóøåíèå ëîêàëüíîé ñîêðàòèìîñòè.
Ïðè ïðîäîëæåíèè ëå÷åíèÿ àíòðàöèêëèíîâûìè ïðåïàðàòàìè ó òàêèõ ïàöèåíòîâ âûøå ðèñê ðàçâèòèÿ õðîíè÷åñêîé äîêñîðóáèöèíîâîé êàðäèîìèîïàòèè, ïîýòîìó ïðîôèëàêòèêà æåëàòåëüíà. Ññûëêè ïî òåìå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] P.S. Åñëè èíòåðåñíî ìîãó âûëîæèòü ñëó÷àé îñòðîé äîêñîðóáèöèíîâîé êàðäèîìèîïàòèè ó ìîëîäîãî ïàöèåíòà ñ ëèìôîãðàíóëåìàòîçîì. |
#10
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×åñòíî ñêàçàòü, ñ ïðàêòè÷åñêîé òî÷êè çðåíèÿ î÷åíü ñêâåðíàÿ òåìà. Ìíå èíîãäà äðóçüÿ îíêîëîãè ïðèñûëàþò ïàöèåíòîâ ñ âîïðîñîì, à ìîæíî ëè êàïàòü êðàñíóþ õèìèþ.
È âîò äóìàåøü, ÷òî èì ñîêðàòèò æèçíü - îòêàç îò ñëåäóþùåãî êóðñà õèìèè èëè ÕÑÍ. Ñòàðàþñü íå îòêàçûâàòü. |
#11
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#12
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Îáåùàííûé ñëó÷àé, ïðîùó ïðîùåíèÿ çà çàäåðæêó.
Öèòàòà:
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#13
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Öèòàòà:
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#14
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Aortic insufficiency is a chronic heart condition that occurs when the aortic valve's initial large stroke volume is released and the Venturi effect draws the walls together, which obstructs blood flow, which leads to a Pulsus Bisferiens.
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#15
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Öèòàòà:
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