轻链型心肌淀粉样变患者化疗前后左心室功能及血清标记物的改变  

Investigation of left ventricular function and biomarkers following chemotherapy in patients with light-chaincardiac amyloidosis

作　　者：杨帆[1] 刘丽文[1] 王静[1] 张明[2] 左蕾[1] 雷常慧 拓胜军[3] 

机构地区：[1]解放军第四军医大学西京医院超声医学科,西安710032 [2]解放军第四军医大学西京医院肾脏内科,西安710032 [3]延安市人民医院超声诊断科

出　　处：《中华超声影像学杂志》2017年第11期928-933,共6页Chinese Journal of Ultrasonography

基　　金：国家国际科技合作专项（2014DFA31980）;国家自然科学基金（81671693,81601498）;陕西省重点项目（S2017-ZDYF-ZDXM-SF-0123）

摘　　要：目的采用三维斑点追踪成像（3D STI）技术评估轻链型心肌淀粉样变（AL—CA）患者化疗前后左室功能变化，以期找到可以预测化疗效果和具有随访价值的超声参数。方法选取经活检确诊为AL—cA的患者13例，经正规化疗6个月。收集患者的临床资料；患者化疗前后行常规心脏超声检查和3D-STI，获得左室最大室壁厚度（MLVWT）、左室质量指数（LVMI）、左室射血分数（LVEF）、二尖瓣环收缩期和舒张早期速度（S’和e’）、左室三维整体纵向、径向、圆周和面积应变（GLS、GRS、GCS和GAS），以及左室16节段达峰时间标准差（TS—SDGLS）。此外，获取患者化疗前后血清学指标，包括N-末端脑钠肽前体（NT—proBNP）和致病游离轻链（FLc）。根据化疗后FLC差值变化将患者分为治疗完全有效（cR）组和不完全有效（Non-CR）组。两组临床资料、心脏超声参数和血清学指标进行组间比较，每组化疗前后各参数进行组内比较。结果①CR组化疗后GLS绝对值较化疗前升高（P=0．036），其升高与NT—proBNP下降相关（r=-0．738，P=0．037）；其余参数无明显变化。Non-CR组化疗前后所有超声参数均无明显改变。②两组化疗前超声参数比较发现，NomCR组LVMI较大，e’和GLS绝对值较低，TS-SD—GLS延长（均P〈0．05）。③ROC分析表明这些参数可对化疗效果进行预测，即对于化疗前LVMI〈96．55g／m2，e’〉4．7cm／s，GLs绝对值〉16．6％，TS-SDGLS％35．2ms的患者，化疗可能有较好效果。结论GLS可识别AL—CA患者化疗后早期左室功能改善；化疗前LVMI、e’、GLS和T争sD—GLS可对化疗短期效果进行预测。Objective To assess whether strain parameters derived from three-dimensional speckle tracking imaging （3D-STI） could identify improvement of cardiac function and predict response of patients with immunogiobulin light-chain cardiac amyloidosis （AL-CA） following chemotherapy. Methods Totally 13 patients with AL-CA [aged （58.5 ± 8.9）years;69 males] were treated with melphalan or bortezomib- based regimens and by regular chemotherapy for 6 months. The clinical data was collected. Maximal left ventricular wall thickness （MLVWT）, left ventricular mass index （LVMI）, left ventricular ejection fraction （LVEF）, systolic mitral annular velocity （st）, early diastolic mitral annular velocity echocardiography （e＇）, 3D-STI global longitudinal, circumferential, radial and area strain （GLS, GCS, GRS, and GAS）, the standard deviation of time to peak longitudinal strain among 16 left ventricular segments （TS-SD_GLS） were obtained by conventional eehocardiography and 3D-STI. In addition, serologic biomarkers including N- terminal pro-brain natriuretic peptide （NT-proBNP） and free light chains （FLC） were acquired at baseline and 6 months after chemotherapy. These patients were divided into two groups according to difference ofFLC：complete response （CR） group and Non-CR group. The clinical data, cardiac ultrasound parameters and serological parameters were compared between groups, each group parameters at baseline and 6 months after chemotherapy were compared within the group. Results （i） There were no significant difference in conventional eehocardiographic parameters, GCS, GRS and GAS, as well as TS-SD_GLS in either group between before and after chemotherapy. But GLS was improved only in CR group （ P = 0.036）, and its improvement was correlated with the decrease in NT-proBNP （ r = -0. 738, P = 0.037）. In baseline evaluation, patients in Non-CR group had increased LVMI, deteriorated er and GLS, and longer Ts-SD as compared to those in CR group （all P 〈0.05）.

关 键 词：超声心动描记术 轻链型心肌淀粉样变性 心室功能 左 三维斑点追踪成像 血清 标记物 化疗 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]