左心室整体心肌应变分析乳腺癌术后蒽环类化疗药物心脏毒性  

Applications of global left ventricular myocardial strain in detection of anthracycline-induced cardiotoxicity in breast cancer survivors with postoperative chemotherapy

作　　者：韩勇[1] 董云[1] 刘怡[1] 夏良华[1] 陈明[1] 

机构地区：[1]同济大学附属东方医院心脏医学部心超室,上海200120

出　　处：《中华超声影像学杂志》2014年第2期104-108,共5页Chinese Journal of Ultrasonography

基　　金：上海市浦东新区科技发展基金创新资金项目（PKJ2010-Y16）;上海市浦东新区心血管疾病学科群项目（PWZxkq20lO-01）

摘　　要：目的采用三维斑点追踪成像（3D-STI）技术分析乳腺癌术后蒽环类药物化疗患者的左室心肌功能，并探讨左室整体应变参数对其心脏毒性的临床价值。方法将入选的51例乳腺癌术后采用葸环类药物化疗的女性患者依照不同化疗周期，分别采集化疗前基础状态、化疗3个周期、6个周期三个时点的常规超声心动图参数和3D-STI应变参数，并人选31例健康女性志愿者作为正常对照组进行比较。利用ROC曲线分析三维应变参数对乳腺癌患者化疗后心脏毒性的临床价值。结果乳腺癌化疗组左室整体纵向收缩期峰值应变（GLS）、左室整体面积应变（GAS）均较对照组和化疗前基础状态减低，差异有统计学意义（P〈O．05）。乳腺癌组各时点间的常规超声心动图参数差异无统计学意义（P〉0．05）。ROC曲线显示，左心室GAS的曲线下面积为0．894，以-28．4％为截断点时，其特异性为88．0％，敏感性为82．9％；GLS的曲线下面积为0．802，以-14．3％作为截断点时，其特异性为62．0％，敏感性为85．4％。结论GAS检出蒽环类药物心脏毒性的特异性最佳，而GLS敏感性最高。3D-STI可在早期检测乳腺癌术后蒽环类化疗药物导致的心脏毒性损害，具有较高的临床参考价值。Objective To assess the clinical significance of three-dimensional speckle tracking imaging （3D-STI） in the evaluation of left ventricular myocardial function in breast cancer survivors with postoperative anthracycline-based chemotherapy. Methods A total of 51 breast cancer survivors with postoperative anthracycline-based chemotherapy were recruited and 31 female healthy volunteers as the controls. Conventional echocardiography and 3D-STI derived parameters [including global longitudinal strain （GLS） and global area strain （GAS）] were measured before and at 3 and 6 anthracycline-based chemotherapeutic cycles. The receiver operating characteristics （ROC） curve was constructed to determine optimal sensitivity and specificity of 3D-STI derived parameters for the prediction of future cardiotoxicity. Results In comparison with the controls and baseline cases,GLS and GAS deteriorated significantly （ P 0. 05 for both）. No statistical difference in GCS and conventional parameters showed before and after the initiation of chemotherapy （ P d0.05 ,respectively）. The ROC curves showed that GAS as the best 3D-STI predictor of patients who develop cardiotoxicity during the follow-up. The area under ROC（AUC） of GAS was 0. 894,and its optimal cut-off value was -28.4%, with a specificity of 88.0% and a sensitivity of 82.9%. AUC of GLS was 0. 802,and its optimal cut-off value was - 14. 3% ,with a specificity of 62.0% and a sensitivity of 85.4%. Conclusions Early decreases in GAS and GLS based on 3D-STI may allow the prediction of subsequent cardiotoxic development accurately in breast cancer survivors with postoperative anthracycline-based chemotherapy.

关 键 词：超声心动描记术 乳腺肿瘤 心室功能 左 蒽环类 心脏毒学类 斑点追踪显像 

分 类 号：R737.9[医药卫生—肿瘤]