应用3D-STI监测乳癌术后蒽环类药物致左室扭转运动及心肌应变的改变  

Application of 3D-STI to monitor left ventricular torsion and changes of myocardial strain in breast cancer patients receiving anthracycline therapy

作　　者：胡莉莉[1] 郑慧[1] 许芳芳[1] 周旺[1] 陈娜[1] 李朝密 杨筱威 

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乳腺外科,合肥230022

出　　处：《安徽医科大学学报》2018年第2期288-292,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省公益性研究联动计划项目(编号:1604f0804027)

摘　　要：目的应用三维斑点追踪成像技术监测乳癌术后患者蒽环类化疗药物致左室扭转运动及心肌应变的改变。方法选择47例乳癌术后行蒽环类药物化疗的患者,分别于累积剂量达0、120、240、360 mg/m^24个时点获取左室扭转及应变参数:左心室扭转角度峰值(Ptw)、左心室扭矩(Tor)、整体纵向应变、整体圆周应变、整体径向应变,进行统计学分析,并利用受试者工作特征曲线(ROC)分析各参数对于评价左室运动功能早期改变的价值。选取22例女性志愿者作为对照组。结果蒽环类化疗药物累积剂量达120 mg/m^2时,Ptw、Tor明显低于0 mg/m^2及对照组(P<0.05)。分析ROC曲线得出:Ptw的ROC曲线下面积为95.8%,截断值为11.0°,此时判断发生心肌毒性的特异性为85.1%,敏感性为93.6%;Tor的ROC曲线下面积为89.6%,截断值为1.3°/cm,此时判断发生心肌毒性的特异性为80.0%,敏感性为89.4%。结论 Ptw、Tor可作为监测蒽环类化疗药物对心室功能早期损害的敏感参数,对指导临床及时调整用药具有较高的参考价值。Objective The changes of left ventricular torsion and strain following the dose accumulation of anthra- cycline in patients with breast cancer was detected by three-dimensional speckle tracking imaging （3D-STI）. Methods A group of 47 breast cancer postoperative patients were recuited and received a six-cycle epirubicinbased chemotherapy. Left ventricular torsion and strain were measured when the epirubicin cumulative dose of 0, 120,240, 360 mg/m^2, They were left ventricular twist （Ptw）, left ventricular torsion （Tor）, global longitudinal strain, global circumferential strain and overall radial strain, the above parameters were compared and analyzed. The receiver operating characteristics （ROC） curve was constructed to determine optimal sensitivity and specificity for early changes in left ventricular systolic function. 22 female healthy volunteers saved as control subjects. Resuits Ptw and Tor were significantly lower at the cumulative dose of 120 mg/m^2 than 0 mg/m^2 （P 〈 0.05 ）. The area under the ROC curve of Ptw was 95.8%, and its optimal cut-off value was 11.0° with a specificity of 85.1% and a sensitivity of 93.6%. The area under the ROC curve of Tor was 89.6% , and its optimal cut-off value was 1.3°/cm with a specificity of 80.0% and a sensitivity of 89.4%. Conclusion Ptw and Tor has a high specificity and sensitivity in detection of ventricular myocardial dysfunction. 3D-STI is useful in early detect the cardiotoxicity of chemotherapeutic agent in breast cancer patients.

关 键 词：乳腺肿瘤 蒽环类 三维斑点追踪成像技术 扭转运动 心肌应变 

分 类 号：R734.2[医药卫生—肿瘤] R445.1[医药卫生—临床医学]