放射性核素平衡法心血池显像评价乳腺癌靶向治疗中的左心室功能  

Evaluation of left ventricular function in breast cancer with targeted therapy by gated equilibration ventriculography

作　　者：陈晨 孙斌[1] 胡四龙 王新村 张勇平 章英剑 Chen Chen;Sun Bin;Hu Silong;Wang Xincun;Zhang Yongping;Zhang Yingjian(Department of Nuclear Medicine, Fudan University Shanghai Cancer Center,Department of Oncology, Shanghai Medical College, Fudan University,Center for Molecular Imaging, Fudan University,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai 200032, China;Department of Electrocardiogram & Pulmonary Function, Fudan University Shanghai Cancer Center, Shanghai 200032, China)

机构地区：[1]复旦大学附属肿瘤医院核医学科、复旦大学上海医学院肿瘤学系、复旦大学生物医学影像研究中心、上海分子影像探针工程技术研究中心,200032 [2]复旦大学附属肿瘤医院心电与肺功能科,上海200032

出　　处：《中华核医学与分子影像杂志》2019年第10期587-590,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨放射性核素平衡法心血池显像对乳腺癌靶向治疗中左心室功能变化的评估作用。方法前瞻性观察2016年2月至2017年12月期间60例女性乳腺癌患者[年龄28~65(48.7±9.4)岁]靶向治疗前后心血池显像结果。根据不同治疗方案将患者分为A组[(紫杉醇注射液(泰素)联合拉帕替尼)]25例[年龄29~65(47.8±11.3)岁]、B组(拉帕替尼)35例[年龄31~62(51.1±8.5)岁]。患者分别在治疗前1个月、治疗6及12个月后进行心血池显像。观察左心室功能指标,包括左心室射血分数(LVEF)、1/3射血分数(EF)、高峰射血率(PER)、高峰射血率时间(TPER)、1/3充盈分数(FF)、高峰充盈率(PFR)及高峰充盈率时间(TPFR)。采用重复测量方差分析、两独立样本t检验和Wilcoxon秩和检验分析数据。结果A组治疗前的PER为(3.60±0.62)舒张末期容积(EDV)/s,治疗6个月后PER与其差异无统计学意义[(3.34±0.57) EDV/s;F=3.447,t=0.51,P>0.05],治疗12个月后PER与其差异有统计学意义[(3.11±0.48) EDV/s;t=0.60,P<0.05];A组治疗前、治疗6和12个月后的PFR分别为(3.57±0.81)、(3.07±0.71)和(2.84±0.54) EDV/s,与治疗前比,治疗6和12个月后的PFR差异均有统计学意义(F=5.345,t=0.82和0.75,均P<0.05)。B组治疗前PFR为(3.23±0.87) EDV/s,治疗12个月后PFR为(2.86±0.55) EDV/s,与治疗前相比降低有统计学意义(F=3.214,t=0.84,P<0.05)。A组治疗6与12个月的PFR下降程度[-0.37(-0.78,0.15) EDV/s]大于B组对应时间PFR的下降程度[-0.13(-0.44,0.17) EDV/s;z=-1.569,P<0.05]。结论核素心血池显像能够有效监测乳腺癌患者靶向治疗后左心室功能的变化,PER和PFR较其他参数能更灵敏地反映心功能变化,联合用药对心功能的影响比应用拉帕替尼单药出现更早。Objective To observe the evaluation function of gated equilibration ventriculography for the changes of left ventricular function in breast cancer with targeted therapy. Methods From February 2016 to December 2017, a total of 60 female breast cancer patients (age: 28-65 (48.7±9.4) years) were included prospectively. Patients were divided into 2 groups: lapatinib combined with taxeme-based chemotherapy group (group A;n=25, age: 29-65 (47.8±11.3) years) and lapatinib monotherapy group (group B;n=35, age: 31-62 (51.1±8.5) years). All patients underwent gated equilibration ventriculography before treatment and 6/12 months after treatment. The parameters of left ventricular function including left ventricle ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), 1/3 ejection fraction (EF), 1/3 filling fraction (FF), time to peak ejection rate (TPER) and time of peak filling rate (TPFR) were observed. Repeated measurement analysis of variance, independent-samples t test and Wilcoxon rank sum test were performed. Results In group A, the PER at 12 months after treatment ((3.11±0.48) end-diastolic volume (EDV)/s) was lower than that before treatment ((3.60±0.62) EDV/s;F=3.447, t=0.60, P<0.05), while there was no statistical difference between PER at 6 months after treatment ((3.34±0.57) EDV/s) and that before treatment (t=0.51, P>0.05);the PFR at 6 months ((3.07±0.71) EDV/s) and 12 months after treatment ((2.84±0.54) EDV/s) declined significantly compared with that before treatment ((3.57±0.81) EDV/s;F=5.345, t=0.82 and 0.75, both P<0.05). In group B, the PFR at 12 months after treatment ((2.86±0.55) EDV/s) declined significantly compared with that before treatment ((3.23±0.87) EDV/s;F=3.214, t=0.84, P<0.05). The decrease of PFR at 6 months and 12 months after treatment in group A was greater than that in group B (-0.37(-0.78, 0.15) vs -0.13(-0.44, 0.17) EDV/s;z=-1.569, P<0.05). Conclusions The gated equilibration ventriculography can effectively monitor the left ventricular function of bre

关 键 词：乳腺肿瘤 分子靶向治疗 心脏毒性 心室功能 左 门控血池显像 

分 类 号：R737[医药卫生—肿瘤]