应变率成像技术监测化疗药物所致心脏毒性的研究  

Study on the SRI in the monitoring of cardiotoxicity induced by chemotherapeutic drug

作　　者：刘俊峰[1] 苏菁[2] 李朝喜[1] 李小娟[1] LIU Jun-feng,SU Jing,LI Chao-xi(Department of Ultrasonography, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China)

机构地区：[1]河北北方学院附属第一医院超声科,河北张家口075000 [2]河北北方学院附属第一医院呼吸内科,河北张家口075000

出　　处：《中国医学装备》2018年第5期64-68,共5页China Medical Equipment

基　　金：河北省卫生厅科研基金项目(20160360)"比较普通超声心动图与超声心动图应变率显像对化疗药物所致的心脏毒性的诊断价值"

摘　　要：目的:探讨应变率成像(SRI)超声影像技术在评价化疗药物致乳腺癌患者左室心肌局部收缩及舒张功能影响中的优势。方法:选择90例经病理确诊的女性乳腺癌患者,经乳腺癌术后均采用辅助5-氟尿嘧啶+表阿霉素+环磷酰胺(FEC)方案化疗。采用自身对照研究对乳腺癌患者1~6周的6个化疗周期进行观察,分别于化疗前1 d及每周期化疗后第5 d行心肌酶学、常规超声心动图及应变率成像检测,并观察各指标变化情况。结果:随化疗药物累积量增加,应变率成像结果显示,第6个周期中部舒张压早起峰值应变率(SRe)、房缩期峰值应变率(SRa)、收缩期峰值应变率(SRs)与化疗前比较明显降低,差异有统计学意义(t=2.401,t=2.246,t=2.334;P<0.05)。化疗后第6个周期与化疗前各部位相比SRe显著性降低,差异有统计学意义(t=9.67,t=5.46,t=7.02,t=9.11,t=7.38,t=8.24;P<0.05);化疗后第6个周期与化疗前各部位相比SRa显著性降低,差异有统计学意义(t=7.21,t=6.21,t=9.48,t=8.72,t=5.47,t=7.39;P<0.05);第6个周期时SRs值明显降低(t=8.18,t=9.27,t=5.37,t=6.25,t=5.54,t=8.93;P<0.05)。常规超声心动图结果显示,化疗后与化疗前相比,第6周期时,患者的二尖瓣口舒张早期血流速度E峰与舒张晚期血流速度A峰比值(E/A)降低,差异有统计学意义(t=6.67;P<0.05);第6周期时谷草转氨酶(AST)、肌酸磷酸激酶同功酶(CPK-MB)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CPK)以及α-羟丁酸脱氢酶(α-HBDH)水平均显著升高(t=9.66,t=7.56,t=5.57,t=6.62,t=8.89;P<0.05)。结论:应变率成像技术能够早期较精确的反映化疗药物对乳腺癌患者左心功能的影响。Objective： To explore the advantage of ultrasonic image technique of strain rate imaging（SRI） in the evaluation for the left ventricular myocardial regional systolic and diastolic function, induced by chemotherapeutic drug, of patients with breast cancer. Methods： 90 female patients with breast cancer who were confirmed by pathological diagnosis were selected in the research. After the operation of breast cancer, all of them were implemented chemotherapy that included auxiliary 5-fluorouracil, pharmorubicin and cyclophosphamide（FEC）. The self-control study was adopted to observe these patients in the 6 chemotherapy cycle from the first week to the sixth week. And the detections of myocardial enzymes, routine echocardiography and SRI were implemented at the first day pre chemotherapy and the fifth day post each chemotherapy period. The change of each indicator was observed. Results： With the increasing of accumulation of chemotherapeutic drug, the results of SRI showed that SRe, SRa and SRs of the middle part of sixth cycle were significantly lower than that of pre chemotherapy（t=2.401, t=2.246, t=2.334, P〈0.05）. The SRe of sixth cycle post chemotherapy was significantly lower than that of various part pre chemotherapy（t=9.67, t=5.46, t=7.02, t=9.11, t=7.38, t=8.24, P〈0.05）. And the SRa of sixth cycle post chemotherapy was significantly lower than that of various part pre chemotherapy（t=7.21, t=6.21, t=9.48, t=8.72, t=5.47, t=7.39, P〈0.05）. The SRs value of sixth cycle was significant decreased（t=8.18, t=9.27, t=5.37, t=6.25, t=5.54, t=8.93, P〈0.05）. On the other hand, the results of routine echocardiography showed that the transmitral diastolic early peak inflow velocity/transmitral diastolic late peak inflow velocity（E/A） of sixth cycle was significantly lower than that of pre chemotherapy（t=6.67, P〈0.05）. The levels of aspartate aminotransferase（AST）, creatine phosphokinase isoenzyme（CPK-MB）, lactate dehydrogenase（LDH）, creatine phosphokinase（CPK）,

关 键 词：应变率成像 化疗 表阿霉素 心脏毒性 乳腺癌 超声心动图 

分 类 号：R445.1[医药卫生—影像医学与核医学]