肌钙蛋白Ⅰ检测联合超声心动图评价兔直线加速器单次照射后心脏损伤的实验研究  

Cardiac troponin I test and echocardiography in assessment of single dose radiation induced rabbit’s heart disease

作　　者：郭建锋[1] 黄敏[1] 吴锦昌[2] 吴传峰[2] 郑凯[1] 

机构地区：[1]南京医科大学附属苏州市立医院东区超声科,江苏苏州215001 [2]南京医科大学附属苏州市立医院东区放疗科,江苏苏州215001

出　　处：《南京医科大学学报（自然科学版）》2012年第10期1381-1385,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：苏州市科技发展项目基金(SS08038)

摘　　要：目的:探讨肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnI)联合超声心动图在评价兔单次照射后急性心脏放射性损伤(radiation induced heart disease,RIHD)上的应用价值。方法:新西兰大白兔25只采用直线加速器进行单次照射。依据照射剂量分为A组(临床相关剂量组)和B组(高剂量组),A组动物剂量和数目分别为0、10、14、18 Gy和3、3、6、7只;B组剂量和数目分别为22、30、40、54 Gy和3、1、1、1只。照射前后进行cTnI和超声心动图检查,超声心动图检查指标包括:①血流脉冲多普勒Tei指数;②组织多普勒:二尖瓣环收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)和舒张晚期峰值速度(Aa),以及Ea/Aa;③常规指标:左心室内径、左心室射血分数(EF)和左心室短轴缩短率(FS)。随访4个月后取兔心进行病理学检查并对RIHD严重程度进行评分。结果:①照射后3 h cTnI开始明显上升,24 h后开始下降,1周后降到基线水平,B组cTnI值明显高于A组;②Sa、Ea和Aa以及Tei指数在不同照射剂量组间以及照射前后存在差异,照射后Sa、Ea和Aa减小,Tei指数增大;照射剂量增大,Sa、Ea和Aa减小,Tei指数增大;左心室大小、EF和FS均无统计学差异;③A组和B组的RIHD的严重程度有差异。结论:心脏在接受单次较大剂量照射后,可以发生急性RIHD,发生几率和严重程度与照射剂量密切相关。Objective：To analyse the value of cardiac troponin I （cTnI） test and echocardiography in evaluating acute radiation induced heart disease（RIHD） after a single dose radiation in a Newzealand rabbit model. Methods：Each rabbit was irradiated with a single dose. According to the radiation dose,25 rabbits were divided into group A （clinical dose group） and group B （high dose group） ,then each group was divided into several subgroups according to the radiation dose. The subgroup＇s dose and the number of group A was 0, 10,14,18 Gy and 3,3,6,7 respectively;the dose and the number of group B was 22,30,40,54 Gy and 3,1,1,1 respectively. Echocardiography and cTnI were detected before and after radiation. The echocardiographic parameters were： （1） flow pulse doppler Tei index; （2） tissue doppler imaging：mitral annulus peak velocities in systole （Sa）,early disatiole （Ea）,late diastole （Aa） and Ea/Aa;（3） conventional parameters：left ventricular diameter, ejection fraction （EF） and fractional shortening（FS）. Then the pathologic changes of heart were semiquantitatively analyzed after 4 months follow-up. Results： （1） cTnI began to increase 3 hours after radiation,reached the apex after 14 to 24 hours,then decreased and stayed at a low level about 1 week;moreover,the level of group B was much higher than that of group A; （2） after radiation, changes in diastolic and systolic ventricular function were observed with a decrease of Sa, Ea, Aa and a increase of the Tel index;furthermore,with the radiation dose increased, the value of Sa, Ea and Aa deceased,and the Tel index increased. Moreover,there were no changes in the conventional parameters. （3） The average severity grade of RIHD in group A and group B was 1 and 1. 5 respectively. Conclusion：Single high dose radiation can lead severe acute RIHD and the severity is related to the radiation dose.

关 键 词：急性心脏放射性损伤 TEI指数 组织多普勒 肌钙蛋白Ⅰ 

分 类 号：R364.3[医药卫生—病理学]