超声心动图分层应变技术评估胸部肿瘤患者放疗后亚临床左室心肌功能障碍  

Evaluation of subclinical left ventricular myocardial dysfunction by echocardiographic layer-specific strain in patients with thoracic tumor after radiotherapy

作　　者：陈璐 吴卫华[1] 马兰[1] 谢晓奕[1] 顾淑莲 Chen Lu Wu Weihua Ma Lan Xie Xiaoyi Gu Shulian(Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, Chin)

机构地区：[1]上海交通大学附属胸科医院超声科,上海200030

出　　处：《中国心血管杂志》2017年第5期316-321,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的应用二维分层应变技术评估胸部肿瘤患者放疗后早期左心室亚临床心肌功能障碍。方法选择首次接受放疗的胸部肿瘤患者31例,采用二维分层应变技术检测所有患者在放疗前、放疗期间及放疗结束后的左室心内膜下、中层以及心外膜下心肌的整体纵向收缩期峰值应变(GLS-endo、GLS-mid、GLS-epi),并计算各层放疗前后各层心肌纵向应变的变化率(△GLS-endo%、△GLS-mid%、△GLS-epi%)。结果与放疗前比较,放疗期间GLS-endo、GLS-mid以及GLS-epi的绝对值显著减低(均为P<0.05),放疗后上述指标进一步减低(均为P<0.05)。放疗前后纵向应变变化率至内向外逐层递减,即△GLS-endo%>△GLS-mid%>△GLS-epi%(均为P<0.05)。△GLSendo%与心脏平均照射剂量、左心室平均照射剂量、受照射≥5 Gy及≥30 Gy的左室体积百分比(LVV5、LV-V30)等呈线性正相关(r值分别为0.475,0.601,0.628,0.799,均为P<0.05)。多元回归分析显示,LV-V30及LV-V5与△GLS-endo%独立相关(标准化β值分别为0.648,0.283,均为P<0.05)。结论胸部肿瘤患者放疗后早期左室三层心肌均出现亚临床功能障碍,其中以心内膜下心肌损害最为显著,其损害程度与左室受照射的累积剂量相关。Objective To evaluate the early-stage left ventricular subclinical myocardial dysfuncion of the patients with thoracic tumor after radiotherapy（ RT） by layer-specific strain. Methods Thirty-one patients with thoracic tumors,undergoing only adjuvant RT,were prospectively recruited. Echocardiography was performed at before RT,during RT and after RT. Layer-specific global longitudinal peak strains were assessed from endocardium,mid-myocardium,and epicardium（ GLS-endo,GLS-mid,GLS-epi） by 2-dimensional speckletracking imaging（ 2D-STI）. The rate of change of layer-specific strains from baseline to after RT（ △GLSendo%,△GLS-mid%,△GLS-epi%） were calculated. Results The absolute values of GLS-endo,GLS-mid and GLS-epi were significantly reduced during RT and further reduced after RT（ all P〈0. 05）. The change rate of longitudinal strain before and after radiotherapy was decreased gradually,that is,△GLS-endo%〉 △GLSmid% 〉△GLS-epi%（ all P〈0. 05）. A positive correlation between △GLS-endo% and mean dose of the whole heart,left ventricular（ LV） mean dose,the percentage of LV volume receiving≥5 Gy and≥30 Gy（ V5,V30） was observed（ r = 0. 475,0. 601,0. 628,0. 799,respectively,all P〈0. 05）. Multiple regression analysis showed that there was an independent relationship between △GLS-endo% with V30（ Standardized β = 0. 648）and V5（ Standardized β = 0. 283）（ all P〈0. 05）. Conclusions Three-layer myocardium of left ventricle were all damaged in patients with thoracic tumor by RT,among which the endomyocardium was most sensitive and its injury was closely related to the cumulative dose of left ventricular irradiation.

关 键 词：心肌疾病 分层应变 放疗 胸部肿瘤 

分 类 号：R540.45[医药卫生—心血管疾病] R730.55[医药卫生—内科学]