三维斑点追踪技术评价蒽环类药物对乳腺癌患者左室心肌功能损害  

Evaluation of the left ventricular myocardial dysfunction in patients with breast cancer after receiving Anthracycline by three-dimensional speckle tracking imaging

作　　者：陈婕[1] 陈剑琼[2] 王玲[1] 杨帆[3] 何丹青[1] 吴媛媛[1] 

机构地区：[1]安徽医科大学第一附属医院超声科,合肥230022 [2]安徽医科大学第一附属医院肿瘤内科 [3]安徽医科大学第一附属医院乳腺外科

出　　处：《中华超声影像学杂志》2015年第9期763-767,共5页Chinese Journal of Ultrasonography

基　　金：安徽省公益性技术应用研究联动计划项目（1501ld04039）

摘　　要：目的探讨三维斑点追踪显像（three-dimensional speckle tracking imaging，3D-STI）技术检测蒽环类药物（anthracycline，ATC）对乳腺癌患者左室心肌功能早期损害的价值。方法乳腺癌术后患者63例，均采用6周期以表柔比星为主的化疗方案，分别于化疗前及表柔比星累计剂量达120mg／m^2、240mg／m^2、360mg／m^2后24～48h内常规进行心电图、二维超声心动图及3D-STI监测。以ROC曲线下面积评价左室整体面积应变（GAS）、整体纵向应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）检测左室功能早期损害准确性，并寻找其检测敏感性及特异性的截断值。21例女性志愿者作为对照组。结果GAS和GLS在表柔比星累计剂量达240mg／m^2、360mg／m^2时较对照组、化疗前明显减低（P〈0．05），其中GAS的ROC曲线下面积为0．974，截断值为一31．5％，判断蒽环类药物对左室功能损害的敏感性为87．1％，特异性为92．9％。GAS与表柔比星累计剂量之间显著相关（r=一0．834，P〈0．01）。结论化疗进程中GAS检测蒽环类药物心脏毒性的敏感性、特异性较高，3D-STI是检测蒽环类药物对乳腺癌患者左室心肌功能早期损害的可靠方法。Objective To explore the value of three-dimensional speckle tracking imaging （3D-STDin early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving Anthracycline. Methods A group of 63 breast cancer postoperative patients were recruited and received a six-cycle epirubicin-based chemotherapy. Electrocardiogram, conventional echocardiography and 3D-STI parameters were measured before chemotherapy and during 24 - 48 hours after the cumulative dose of 120 mg/m^2 ,240 mg/m^2 and 360 mg/m^2. The receiver operating characteristics （ROC） curves of 3D-ST1 parameters, such as global area strain（GAS）, global longitudinal strain（GLS）, global circumferential strain （GCS） ,and global radial strain（GRS） were drawn to determine optimal sensitivity and specificity. Twenty- one healthy female volunteers served as control subjects. Results Compared with before chemotherapy and control subjects,GAS and GLS were significantly reduced at the cumulative dose of 240 mg/m^2 ,360 mg/m^2 （ P 〈0.05）. The area under ROC of GAS was 0.974, and its optimal cut-off value was -31.5 %, with a specificity of 87.1% and a sensitivity of 92.9%. Moreover, correlation analysis showed GAS was significantly associated with cumulative doxorubicin dose（ r = -0.834, P 〈0.01）. Conclusions During chemotherapy, GAS can detect minor LV myocardial dysfunction associated with cardiotoxicity of anthracycline. 3D-STI is useful in early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving anthracyeline.

关 键 词：超声心动描记术 乳腺肿瘤 蒽环类 心室功能 左 三维斑点追踪显像 

分 类 号：R737.9[医药卫生—肿瘤] R540.45[医药卫生—临床医学]