| Background and ObjectiveAcute myeloid leukemia(AML) is a hematological malignancy of high mortality, with an increasing incidence in recent years. With the development of medical technology, traditional chemotherapy as well as apoptosis inducers, protein kinase targeting therapy, monoclonal antibodies, tumor vaccines, hematopoietic stem cell transplantation are becoming available clinically. Despite of all these new options, chemotherapy is still the most basic and effective one. Daunorubicin(DNR) is still irreplaceable, it can improve the complete remission rate and prolong the overall survival time of young AML patients by increasing the dose.But dose-dependent myocardial damage is the most significant non-hematological toxicity which will greatly impair the patient's quality of life and even be fatal. The key problems facing us are discovering the potential cardiotoxic mechanisms and finding rescue drugs.Traditional chinese medicine has made a great progress in this field mainly focusing on eliminating oxygen free radicals and reducing lipid peroxidation. Rebalancing oxygen free radicals are promising in reducing myocardial damage. Besides, traditional chinese medicine can improve coronary blood flow which is beneficial for myocardial metabolism and DNA synthesis of impaired cardiac cells, therefore accelerating recovery. It is attracting more concerns as an effective and less toxic cardiac protecting agent. Shen Mai injection is relatively commonly used in practice. Physicians can moniter electrocardiogram(ECG), myocardial enzymes and echocardiogram to prove its effect on reducing cardiac damage. NT-proBNP is a sensitive biological marker for early recognization of cardiac injury which is important for early diagnose, treatment and prognosis. Thus it might become a promising marker for anthracycline-related cardiac toxicity. There is not much research on NT-proBNP level changes after intravenous Shen Mai for rescuing anthracycline-related cardiac toxicity. So we use NT-proBNP as a marker to prove the cardiac protective effect of Shen Mai injection especially its protective effect on early cardiotoxicity which will provide an objective evidence of traditional chinese medicine's protective effect during chemotherapy.Method80 patients newly diagnosed of AML in Hebei Medical University Affiliated Langfang Traditional Chinese Medicine Hospital during June,2010 to December,2010 were included and randomly assigned to two groups:40 patients in the therapy group treated with Shen Mai injection and 40 patients in the control group treated with placebo. NT-proBNP, ECG, myocardial enzymes(CK, CKMB) levels were documented before and after 3 weeks of chemotherapy to evaluate the effect of Shen Mai injection on cardiac cells after DNR was used.ResultsThere was no statistical significances in ECG abnormalities between the two groups, P>0.05. There was no statistical significances in myocardial enzymes before and after chemotherapy between the two groups, P>0.05. None of the patients with ECG abnormalities in the two groups had abnormal myocardial enzyme level. There was no statistical significances in complete response rate (CR) and total effective rate (CR, PR), P>0.05. After chemotherapy, NT-proBNP in both groups elevated(P<0.05) especially those with ECG abnormalities. NT-proBNP was much higher in the control group than in the therapy group (P<0.05).Effect of the therapy group improved TCM symptoms is better than the control group.ConclusionsAsymptomatic myocardial toxicity can develop in AML patients treated shortly after with DNR, which may present with ECG abnormalities, unsignificant myocardial enzyme(CK, CKMB) level changes, but NT-proBNP may elevate remarkably and rapidly. Intravenous Shen Mai during chemotherapy can decrease NT-proBNP level after DNR was used, improve the TCM syndrome effectively,which may partially explain its cardiac protection effect of Shen Mai injection. |
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