三维斑点追踪显像技术评价食管癌患者同步放化疗中左心室功能的早期改变  

Early detection of left ventricular dysfunction in patients with esophageal cancer during concurrent chemoradiotherapy by real-time three-dimensional speckle tracking echocardiography

作　　者：方晓燕 程蕾蕾 潘向欧 张楚婕 赵睿 曾昭冲 舒先红 王小林 Fang Xiaoyan;Cheng Leilei;Pan Xiang＇ ou;Zhang Chujie;Zhao Rui;Zeng Zhaochong;Shu Xianhong;Wang Xiaolin(Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai Institute of Medical Imaging,Shanghai Institute of Cardiovascular Diseases,Shanghai 200032,Chin)

机构地区：[1]复旦大学附属中山医院上海市影像医学研究所上海市心血管研究所心脏超声诊断科,上海200032 [2]复旦大学附属中山医院上海市影像医学研究所上海市心血管研究所放疗科,上海200032 [3]复旦大学附属中山医院上海市影像医学研究所上海市心血管研究所介入治疗科,上海200032

出　　处：《中华超声影像学杂志》2018年第7期553-558,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81771840）;上海市卫生系统优秀人才培养计划（2017BR027）;上海市卫生和计划生育委员会科研项目（20174Y0165）

摘　　要：目的应用三维斑点追踪显像（3D-STE）技术评价食管癌患者同步放化疗中左心室功能的早期改变，并分析其影响因素。方法拟行同步放化疗的食管癌患者31例，均于放化疗前及放疗剂量累积至40Gy时接受超声心动图检查，三维图像脱机分析获得左室舒张末容积（EDV）、收缩末容积（ESV）、每搏输出量（SV）、左室射血分数（LVEF）、三维整体纵向应变（3DGLs）及三维整体圆周应变（3DGCS）。比较患者治疗前及同步放化疗中超声参数的变化，分析左室超声参数的相关影响因素。结果尽管食管癌患者同步放化疗中的左室内径、左室容积及LVEF较治疗前差异无统计学意义（P〉0．05），但左室舒张功能指标E／A和Em／Am降低，E／Em升高（P〈0．05）。食管癌患者同步放化疗中的左室3DGLS较治疗前显著降低（P〈0．05）。左室3DGCS亦较治疗前降低，但差异无统计学意义（P〉0．05）。多因素线性回归分析显示，心脏V40（接受40Gy照射剂量的心脏体积百分比）是食管癌患者同步放化疗中左室3DGLS的独立影响因子（P〈0．05）。结论3D-STE能够检测食管癌患者同步放化疗中左室功能的早期改变，左室3DGLS是评价食管癌患者同步放化疗中亚临床心脏损伤的敏感参数，心脏V40是左室3DGLS的独立影响因子。Objective To evaluate left ventricular （LV） dysfunction in patients with esophageal cancer （EC） during concurrent chemoradiotherapy （CCRT） using real-time three-dimensional speckle tracking echocardiography （3D-STE） and analyze its influence factors. Methods Thirty-one patients with EC who received CCRT were enrolled in the study. Conventional echocardiography and 3D-STE were performed pre-CCRT and during CCRT （radiotherapy dose reached 40Gy）. Three-dimensional parameters including LV end-diastolic volume （EDV）, end-systolic volume （ESV）, stroke volume （SV）, left ventricular ejection fraction （LVEF）, global longitudinal strain （GLS） as well as global circumferential strain （GCS） were compared between pre-CCRT and during CCRT. The independent factors on left ventricular function parameters were analyzed. Results There was no change on LV diameters, LV volumes and LVEF during CCRT （all P 〉0.05）, while LV diastolic function indexes were impaired compared with those of pre- CCRT, demonstrated by the decreased E/A, Era/Am, and increased E/Em（all P 〈0.05）. 3DGLS was also significantly decreased during CCRT compared with that of pre-CCRT （P（0.05）, but no significant difference was found in 3DGCS （ P 〉0.05）. Multivariate linear regression analysis manifested that cardiac V40（the percentage of cardiac volume as radiotherapy dose reached 40Gy） was an independent determinant of LV 3DGLS in patients with esophageal cancer during CCRT （ P 〈0.05）. Conclusions LV GLS provided by real-time 3D-STE could sensitively detect CCRT-induced myocardial injury. Cardiac V40 is independently associated with LV 3DGLS during CCRT, representing the impact of radiotherapy on the subclinical LV function change.

关 键 词：超声心动描记术 三维 食管肿瘤 心室功能 左 放化疗 

分 类 号：R540.45[医药卫生—心血管疾病] R735.1[医药卫生—内科学]