二维斑点追踪超声心动图联合超敏心肌肌钙蛋白T检测早期诊断化疗药物引起的隐匿性心脏毒性  

Early detection of the cardiotoxicity induced by chemotherapy drug through two-dimensional speckle tracking echocardiography combined with high-sensitive cardiac troponin T

作　　者：王玮 康瑜[1] 舒先红 沈学东[1] 何奔[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,200127 [2]复旦大学附属中山医院心超室,上海200032

出　　处：《中华肿瘤杂志》2017年第11期835-840,共6页Chinese Journal of Oncology

基　　金：国家自然科学基金青年项目（81401411）;上海自然科学基金青年项目（14zr1425200）

摘　　要：目的 评价二维斑点追踪超声心动图（STE）联合超敏心肌肌钙蛋白T（hs-cTnT）检测早期诊断化疗药引起的隐匿性心脏毒性的价值.方法 75例弥漫大B细胞非霍奇金淋巴瘤（NHL）患者采用CHOP方案化疗,在化疗前、第3个疗程结束后的第2天（化疗中期）和最后1个疗程结束后的第2天（化疗后）进行常规超声和二维STE检查,测量左室整体纵向应变（LS）、环周应变（CS）和径向应变（RS）.在STE检查的同期,测量左室射血分数（LVEF）,并取血测定hs-cTnT.结果 75例NHL患者中,30例患者完成了3个疗程CHOP方案,45例患者完成了6-8个疗程CHOP方案.所有患者化疗前、化疗中期和化疗后的LVEF分别为（63.8±2.6）%、（63.8±2.8）%和（64.0±3.3）%,差异无统计学意义（P=0.91）.75例患者化疗前、化疗中期和化疗后的左室整体LS分别为（-18.5±1.7）%、（-16.5±1.9）%和（-16.0±1.6）%,左室整体 CS分别为（-20.9±2.9）%、（-19.3±3.5）%和（-19.2± 3.2）%,左室整体RS分别为（39.2±6.4）%、（35.3±5.2）%和（35.0±6.2）%,hs-cTnT分别为（0.0010± 0.0020）ng/ml、（0.0063±0.0089）ng/ml和（0.0073±0.0038）ng/ml,化疗中期的左室整体LS、CS和RS均较化疗前显著下降,hs-cTnT较化疗前显著升高,差异均有统计学意义（均P〈0.01）,而化疗后的左室整体LS、CS、RS和hs-cTnT与化疗中期差异无统计学意义（均P〉0.05）.化疗前、化疗中期和化疗后的17节段LS达峰时间标准差（TLS-SD）、12节段CS达峰时间标准差（TCS-SD）和12节段RS达峰时间标准差（TRS-SD）差异无统计学意义（均P〉0.05）.化疗后左室LS降低率与hs-cTnT升高呈正相关（r=0.60,P〈0.01）.结论 二维STE联合hs-cTnT可有效、准确地评估蒽环类药物化疗过程中的隐匿性心脏毒性.Objective To investigate the clinical value of two-dimensional speckle tracking echocardiography（2D-STE）combined with high-sensitive cardiac troponin T（hs-cTnT）in early detection of the cardiotoxicity induced by chemotherapy drug. Methods Seventy-five non-Hodgkin′s lymphoma patients who received the CHOP regimen were recruited in this study. Conventional echocardiography and 2D-STE were performed on these patients before chemotherapy,the second day after the third course of chemotherapy （during chemotherapy）and the second day after the last course of chemotherapy（after chemotherapy）. The parameters included left ventricular ejection fraction（LVEF）, global longitudinal strain（LS）, global circumferential strain（CS）and global radial strain（RS）. The serum hs-cTNT levels were tested simultaneously. Results Three cycles of CHOP were completed in 30 patients and 6-8 cycles of CHOP were completed in 45 patients. The LVEF of 75 patients before, during and after chemotherapy was（63.8 ± 2.6）%,（63.8 ± 2.8）% and（64.0 ± 3.3）%, respectively, without significant difference（P= 0.91）. However,the LS of 75 patients before, during and after chemotherapy was（-18.5 ± 1.7）%,（-16.5 ± 1.9）% and（-16.0±1.6）%,respectively. The CS was（-20.9±2.9）%,（-19.3±3.5）% and（-19.2± 3.2）%,respectively. The RS was（39.2±6.4）%,（35.3±5.2）% and（35.0±6.2）%,respectively. The hs-cTnT was（0.001 0 ± 0.002 0）ng/ml,（0.006 3 ± 0.008 9）ng/ml and（0.007 3 ± 0.003 8）ng/ml, respectively. The LS, CS and RS were significantly decreased while hs-cTnT was significantly increased during chemotherapy when compared to those before chemotherapy（all of P〈0.01）. Alternatively, the LS, CS,RS and hs-cTnT after chemotherapy were marginally different from those during chemotherapy（all of P〉0.05）. Moreover, TLS-SD, TCS-SDand TRS-SDshowed no significant difference before, during and after chemotherapy（all of P〉0.05）. The reduction of LS was positively associa

关 键 词：淋巴瘤 化疗药物 心脏毒性 二维斑点追踪超声心动图 超敏心肌肌钙蛋白T 

分 类 号：R733.1[医药卫生—肿瘤]