{"id":34653,"date":"2024-05-02T17:58:17","date_gmt":"2024-05-02T09:58:17","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=34653"},"modified":"2025-02-11T13:40:08","modified_gmt":"2025-02-11T05:40:08","slug":"diem-tin-hoi-nghi-acc-2024-thu-nghiem-proact-acei-phong-ngua-doc-tinh-tren-tim-o-benh-nhan-ung-thu-dang-hoa-tri-lieu","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/diem-tin-hoi-nghi-acc-2024-thu-nghiem-proact-acei-phong-ngua-doc-tinh-tren-tim-o-benh-nhan-ung-thu-dang-hoa-tri-lieu\/","title":{"rendered":"\u0110i\u1ec3m tin h\u1ed9i ngh\u1ecb ACC 2024: Th\u1eed nghi\u1ec7m PROACT \u2013 ACEI ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111ang h\u00f3a tr\u1ecb li\u1ec7u?"},"content":{"rendered":"\n

Nghi\u00ean c\u1ee9u PROACT \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 l\u00e0m r\u00f5 hi\u1ec7u qu\u1ea3 ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim c\u1ee7a c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin (ACEI) \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa hay lymphoma \u0111ang h\u00f3a tr\u1ecb li\u1ec7u v\u1edbi thu\u1ed1c nh\u00f3m anthracycline. K\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u PROACT \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o t\u1ea1i H\u1ed9i ngh\u1ecb Th\u01b0\u1eddng ni\u00ean c\u1ee7a Vi\u1ec7n Tim m\u1ea1ch Hoa K\u1ef3 (ACC) 2024 v\u00e0o ng\u00e0y 08 th\u00e1ng T\u01b0 v\u1eeba qua. B\u00e0i vi\u1ebft nh\u1eb1m t\u00f3m t\u1eaft k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u PROACT.<\/p>\n\n\n\n

Anthracycline l\u00e0 nh\u00f3m thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0. \u0110\u1ed9c t\u00ednh tr\u00ean tim c\u1ee7a thu\u1ed1c nh\u00f3m anthracycline ph\u1ee5 thu\u1ed9c li\u1ec1u v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn nh\u1eefng t\u1ed5n th\u01b0\u01a1ng tr\u00ean c\u01a1 tim. Ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim l\u00e0 y\u1ebfu t\u1ed1 c\u1ed1t l\u00f5i \u0111\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c t\u00e1c \u0111\u1ed9ng c\u00f3 h\u1ea1i c\u1ee7a \u0111i\u1ec1u tr\u1ecb ung th\u01b0 \u1edf b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau \u0111i\u1ec1u tr\u1ecb ung th\u01b0. ACEI \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i \u00edch trong ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim do thu\u1ed1c nh\u00f3m anthracycline. Do \u0111\u00f3, nghi\u00ean c\u1ee9u PROACT \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 l\u00e0m r\u00f5 hi\u1ec7u qu\u1ea3 c\u1ee7a enalapril trong ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim c\u1ee7a anthracycline \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa v\u00e0 non-Hodgkin Lymphoma.<\/p>\n\n\n\n


H\u00ecnh 1.<\/strong> T\u00f3m t\u1eaft th\u1eed nghi\u1ec7m PROACT<\/p>\n\n\n\n

T\u00f3m t\u1eaft th\u1eed nghi\u1ec7m PROACT<\/strong><\/h2>\n\n\n\n

PROACT l\u00e0 th\u1eed nghi\u1ec7m \u0111a trung t\u00e2m, ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng. Nghi\u00ean c\u1ee9u bao g\u1ed3m 111 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean th\u00e0nh 2 nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi enalapril ho\u1eb7c placebo. Tu\u1ed5i trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u l\u00e0 57 tu\u1ed5i, trong \u0111\u00f3 c\u00f3 78% b\u1ec7nh nh\u00e2n l\u00e0 n\u1eef gi\u1edbi. C\u00f3 62% b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa v\u00e0 38% b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb non-Hodgkin lymphoma. B\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u \u0111\u1ec1u c\u00f3 k\u1ebft qu\u1ea3 \u00e2m t\u00ednh v\u1edbi troponin khi b\u1eaft \u0111\u1ea7u tham gia nghi\u00ean c\u1ee9u. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb 6 chu k\u1ef3 h\u00f3a tr\u1ecb li\u1ec7u v\u1edbi anthracycline (li\u1ec1u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng doxorubicin \u2265 300 mg\/m2<\/sup>). Enalarpil \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n v\u1edbi li\u1ec1u t\u1ed1i \u0111a 20 mg. Trong su\u1ed1t th\u1eddi gian theo d\u00f5i, li\u1ec1u enalapril trung b\u00ecnh \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 17.7 mg.<\/p>\n\n\n\n

Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh c\u1ee7a nghi\u00ean c\u1ee9u l\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u1edbi troponin \u0111\u1eb7c hi\u1ec7u tim (cTnT) \u2265 14 ng\/L. Ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ph\u1ee5 c\u1ee7a nghi\u00ean c\u1ee9u bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh v\u1edbi troponin \u0111\u1eb7c hi\u1ec7u tim I (cTnI) > 26.2 ng\/Ll, ch\u1ec9 s\u1ed1 s\u1ee9c c\u0103ng d\u1ecdc th\u1ea5t tr\u00e1i (left ventricular global longitudinal strain) gi\u1ea3m > 15% so v\u1edbi \u0111\u01b0\u1eddng n\u1ec1n v\u00e0 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i gi\u1ea3m > 10% so v\u1edbi \u0111\u01b0\u1eddng n\u1ec1n.<\/p>\n\n\n\n

K\u1ebft qu\u1ea3 cho th\u1ea5y \u0111\u1ed1i v\u1edbi ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh l\u00e0 cTnT, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a gi\u1eefa 2 nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi enalapril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c. C\u1ee5 th\u1ec3 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 cTnT \u2265 14 ng\/L \u1edf nh\u00f3m enalapril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c l\u1ea7n l\u01b0\u1ee3t l\u00e0 78% v\u00e0 83% (kh\u00e1c bi\u1ec7t kh\u00f4ng c\u00f3 \u00fd ngh\u0129a, p = 0.405).<\/p>\n\n\n\n

T\u01b0\u01a1ng t\u1ef1, \u0111\u1ed1i v\u1edbi c\u00e1c ti\u00eau ch\u00ed cTnI c\u0169ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a gi\u1eefa nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi enalapril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c. T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed1ng \u0111\u1ed9 cTnI > 26.2 ng\/L \u1edf nh\u00f3m enalapril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c l\u1ea7n l\u01b0\u1ee3t l\u00e0 47% v\u00e0 45% (kh\u00e1c bi\u1ec7t kh\u00f4ng c\u00f3 \u00fd ngh\u0129a, p = 0.819). C\u00e1c ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ph\u1ee5 kh\u00e1c nh\u01b0 ch\u1ec9 s\u1ed1 \u1ee9c c\u0103ng d\u1ecdc th\u1ea5t tr\u00e1i v\u00e0 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i c\u0169ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa 2 nh\u00f3m enalapril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c (p = 0.921 v\u00e0 p = 0.236). T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 s\u1ed1 s\u1ee9c c\u0103ng d\u1ecdc th\u1ea5t tr\u00e1i gi\u1ea3m > 15% \u1edf nh\u00f3m enalapril l\u00e0 21%, t\u1ef7 l\u1ec7 n\u00e0y \u1edf nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c l\u00e0 22%. T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i gi\u1ea3m > 10% \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi enalapril l\u00e0 4% v\u00e0 \u1edf nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c l\u00e0 0%.<\/p>\n\n\n\n

K\u1ebft lu\u1eadn<\/strong><\/h2>\n\n\n\n

Nh\u01b0 v\u1eady k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m PROACT chot h\u1ea5y enalapril kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1ed9c t\u00ednh tr\u00ean tim c\u1ee7a anthracycline \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ung th\u01b0 v\u00fa v\u00e0 lymphoma. Vi\u1ec7c b\u1ed5 sung enalapril v\u00e0o ch\u1ebf \u0111\u1ed9 ch\u0103m s\u00f3c ti\u00eau chu\u1ea9n kh\u00f4ng v\u01b0\u1ee3t tr\u1ed9i h\u01a1n trong ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim \u1edf b\u1ec7nh nh\u00e2n h\u00f3a tr\u1ecb v\u1edbi anthracycline li\u1ec1u cao.<\/p>\n\n\n\n

\n\n\n\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/h3>\n\n\n\n
    \n
  1. American College of Cardiology news story. PROACT: Do ACE Inhibitors Help Prevent Cardiotoxicity in Patients Treated For Breast Cancer or Lymphoma?. Updated 08 Apr. Accessed date 21 Apr. URL: https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2024\/04\/02\/17\/02\/mon-830am-proact-acc-2024<\/li>\n\n\n\n
  2. ACC.24 Presentation Slides. PROACT. Updated 08 Apr. Accessed date 21 Apr. URL: https:\/\/www.acc.org\/education-and-meetings\/image-and-slide-gallery\/media-detail?id=8a0f9267d356440c8518e021e8f89cbe<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Nghi\u00ean c\u1ee9u PROACT \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 l\u00e0m r\u00f5 hi\u1ec7u qu\u1ea3 ph\u00f2ng ng\u1eeba \u0111\u1ed9c t\u00ednh tr\u00ean tim c\u1ee7a c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin (ACEI) \u1edf b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa hay lymphoma \u0111ang h\u00f3a tr\u1ecb li\u1ec7u v\u1edbi thu\u1ed1c nh\u00f3m anthracycline.<\/p>\n","protected":false},"author":123,"featured_media":34725,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1436],"articles_languages":[1375],"articles_filters":[],"class_list":["post-34653","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/34653","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=34653"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/34653\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/34725"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=34653"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=34653"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=34653"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=34653"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=34653"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=34653"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}