左房容积指数评价赫赛汀对乳腺癌患者左室舒张功能的影响及与E/Em之间的关系  

The effect of LAVI in the evaluation of left ventricular diastolic function in patients with breast cancer treated by herceptin and the relationship between LAVI and E/Em

作　　者：吴斌[1] 万冬冬[2] 李振楠[1] 陆卫[3] 殷艳[1] 

机构地区：[1]江苏省海门市人民医院超声科,海门226100 [2]江苏省海门市人民医院肿瘤科,海门226100 [3]江苏省启东市中医院理疗科

出　　处：《南通大学学报（医学版）》2017年第3期211-215,共5页Journal of Nantong University(Medical sciences)

基　　金：海门市财政基金资助项目(2014SF04)

摘　　要：目的:探讨左房容积指数(left atrial volume index,LAVI)在评价赫赛汀治疗乳腺癌患者左室舒张功能变化中的价值。方法:选取2013年5月—2015年10月来我院治疗的女性乳腺癌术后患者86例,分为仅接受多西紫杉醇化疗组36例(A组)及接受多西紫杉醇+赫赛汀联合化疗组50例(B组),同时选取50例健康女性作为对照组(C组)。于入组及化疗第3、6、9月末时分别获取各组LAVI、舒张早期二尖瓣血流峰速度/舒张早期二尖瓣环峰速度(early diastolic mitral inflow velocity/early diastolic mitral annular inflow velocity,E/Em)值及其他主要指标值并作比较。结果:(1)B组自身前后比较:化疗后第3、6、9月末的LAVI及E/Em水平均与入组时差异有统计学意义。(2)A组各指标自身前后比较均差异无统计学意义。(3)A、B、C组间比较:化疗后第3、6、9月末,B组的LAVI水平均显著高于A组、C组同期水平(P<0.01)。化疗后第6、9月末B组的E/Em显著高于A组、C组同期水平(P<0.01)。(4)相关性分析:LAVI与E/Em呈正相关(r=0.850),与左室射血分数(left ventricular ejection fraction,LVEF)呈负相关(r=-0.222)。(5)当LAVI>29.07 m L/m2时,LAVI诊断左室舒张功能不全的敏感性为75%,特异性为79%,此时敏感性+特异性最大。结论:LAVI与反映左室充盈压的组织多普勒参数E/Em比值有良好的相关性,可作为诊断左室舒张功能不全的指标;LAVI值越大,左室舒张功能受损越严重;经多西紫杉醇+赫赛汀联合化疗3个月后,左室舒张功能即发生显著变化。Objective： To evaluate ventricular diastolic function in patients with breast cancer treated with herceptin by researching the value of atrial volume index（LAVI）. Methods： 86 breast cancer patients were chosen from May 2013 to October 2015 in our hospital, we divided them into group A and group B. In group A, 36 patients were enrolled who received docetaxel chemotherapy. And in group B, 50 patients were enrolled, who received docetaxel ＋Herceptin combined with chemotherapy. At the same time, 50 healthy women were selected as group C. Group C was set as the control group. We obtained LAVI, E/Em value and other main index values at the beginning and at the end of third, and sixth and ninth month after chemotherapy respectively. Results： （1）The levels of LAVI and E/Em of group B at the end of the 3rd, 6th and 9th month after chemotherapy were significantly different from those just into the group. （2）Comparison of their own before and after chemotherapy, there were no significant differences in the levels of LAVI and E/Em of group A. （3）Comparison between groups A, B, C： at the end of third, sixth, ninth month after chemotherapy, the LAVI level of B group was significantly higher than that of group A, C at the same time（P〈0.01）. Only at the end of sixth and ninth month, the E/Em of the B group was significantly higher than that of group A, C at the same time. There was no significant difference in the levels of E/Em and LAVI between C and A in each period（P〉0.05）. （4）Correlation analysis： LAVI was positively correlated with E/Em（r=0.850）, LAVI was negatively correlated with left ventricular ejection fraction（LVEF）（r=-O.222）.（5）When LAVI〉29.07 mL/m2, The sensitivity of diagnosing ventricular diastolic dysfunction was 75%, the specificity of it was 79%, the sum of sensitivity and specificity was maximum. Conclusions： E/Em had a good correlation with the Doppler parameter LAVI ratio which reflected the left ventricular filling pressure. It can be used as a

关 键 词：乳腺癌 左房容积指数 左室舒张功能不全 左室充盈末压 赫赛汀 

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