定量组织多普勒成像技术评价白血病患儿化疗前后左心室功能的临床研究  

Clinical value of quantitative tissue velocity imaging in the evaluation of leukemia children＇s left ventricular function before and after chemotherapy

作　　者：李晔[1] 刘宇杰[2] 田家玮[2] 李树林[1] 

机构地区：[1]哈尔滨医科大学第一临床医院儿内科,150001 [2]哈尔滨医科大学第一临床医院超声科,150001

出　　处：《中国小儿急救医学》2007年第2期112-115,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的 探讨定量组织多普勒速度成像技术（QTVI）对白血病患儿化疗前后左心整体及局部功能变化的诊断价值。方法 将16例急性白血病患儿按照化疗剂量分为两组：Ⅰ组化疗药物累积剂量为120～180mg／m2，Ⅱ组为240360mg／m^2。另设22例正常儿为对照组。用常规检测超声心动图Simpson法测量左心整体收缩功能，用频谱多普勒检测左心整体舒张功能，用QTVI分别测量心脏瓣环及各室壁节段的局部收缩和舒张功能，对比研究QTVI技术和常规超声心功检测法对白血病化疗的心脏毒性的检测效果。结果 化疗前Ⅰ、Ⅱ组与正常儿比较各参数差异无显著性（P〈0．05）。Simw,on法未发现Ⅰ、Ⅱ组收缩功能异常；QTVI发现侧壁的VS环较化疗前减低，且有6个节段的VS段有不同程度的下降。在舒张功能的检测方面，频谱多普勒仅于Ⅱ组检出二尖瓣E峰较化疗前降低；而QTVI发现Ⅰ组后间隔、下壁瓣环水平与Ⅱ组六个瓣环水平（包括VE环的均值）较对照组显著降低。结论 QTVI能定量评价左室收缩、舒张期的整体及局部心功能，优于常规超声检测法，并能动态观察急性白血病患儿化疗前后及不同累积剂量对左心功能的影响，为临床提供一种敏感、准确的心脏功能检测新方法。Objective To explore the value of quantitative tissue velocity imaging（QTVI） in detecting leukemia children＇ s integral and regional myocardial function before and after chemotherapy. Methods 16 patients with ALL were confirmed by bone marrow aspiration and divided into two groups： group Ⅰ receiving a small cumulative dose（120-180 mg/m^2） and group Ⅱ with a middle dose（240-360 mg/m^2） of daunorubicin （DNR）. Twenty-two normal subjects were in control group. Left ventricular systolic and diastolic function was measured by the method of Simpson and Doppler respectively. Then QTVI was applied! for detecting mitral annular and allsegments＇ motion velocity in three apical longitudinal views. The value in evaluating left ventricular function by QTVI and uhe regular method was compared. Results The left ventricular function had no obviously difference between control and leukemia children before chemotherapy（ P〈0.05）. The method of Simpson had no positive results in detecting left systolic function. However, QTVI results indicated a decrease in Vs of mitral annular in lateral wall. QTVI also confirmed that Vs of 6 myocardial segments decreased in varying degrees. Moreover, QTVI showed abnormality in the movement of posterior septum and inferior wall in group Ⅰ as well as a decrease in the six mitral annular velocity of VE （The mean value included）. Conclusion QTVI can evaluate the integral and regional myocardial systolic and diastolic function quantitatively and monitor the dynamic changes in myocardial function after chemotherapy. The diagnostic sensitivity of QTVI on myocardial function evaluation is higher than that of regular method. As a sensitivity and accuracy new technology in detecting myocardial function, QTVI sheds new light on clinical application in this area.

关 键 词：定量组织多普勒速度成像技术 左室收缩功能 左室舒张功能 急性白血病 化疗 

分 类 号：R733[医药卫生—肿瘤] R44[医药卫生—临床医学]