门控心肌灌注显像相位分析对弥漫性大B细胞淋巴瘤患者蒽环类药物所致心肌损害的早期诊断价值  

Phase analysis of gated myocardial perfusion imaging for early diagnosis of cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma

作　　者：邱春 林艳[2] 顾伟英[2] 王建锋[1] 邵晓梁[1] 张飞飞 陈佳恬 李小霞 贺白[2] 谢小宝[2] 武志芳[3] 王跃涛[1] Qiu Chun;Lin Yan;Gu Weiying;Wang Jianfeng;Shao Xiaoliang;Zhang Feifei;Chen Jiatian;Li Xiaoxia;He Bai;Xie Xiaobao;Wu Zhifang;Wang Yuetao(Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, the First People′s Hospital of Changzhou, Changzhou 213003, China;Department of Hematology, the Third Affiliated Hospital of Soochow University, the First People′s Hospital of Changzhou, Changzhou 213003, China;Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China)

机构地区：[1]苏州大学附属第三医院、常州市第一人民医院核医学科,213003 [2]苏州大学附属第三医院、常州市第一人民医院血液科,213003 [3]山西医科大学第一医院核医学科,太原030001

出　　处：《中华核医学与分子影像杂志》2019年第10期591-596,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(81701737,81471690);江苏省自然科学基金(BK20150253);江苏省社会发展重点病种规范化诊疗项目(BE2015635);常州市科技支撑计划(社会发展)项目(CE20175029).

摘　　要：目的评价左心室收缩同步性,探讨左心室收缩不同步对弥漫性大B细胞淋巴瘤(DLBCL)患者蒽环类药物化疗所致心肌损害的早期诊断价值。方法前瞻性纳入2016年6月至2019年1月间蒽环类药物治疗前门控心肌灌注显像(GMPI)正常的32例确诊DLBCL患者[男22例、女10例,年龄22~73 (54.4±14.2)岁],蒽环类药物化疗(至少6个疗程)结束后复查GMPI。分析化疗前后心肌损伤标志物、心电图指标、左心室功能[左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、高峰充盈率(PFR)]、室壁运动异常总分(SMS)、室壁增厚异常总分(STS)及左心室收缩同步性[相位直方图带宽(BW)、相位标准差(SD)、熵]的变化。采用配对t检验或Wilcoxon符号秩检验及χ2检验分析数据。结果与化疗前相比,化疗后患者左心室收缩同步性指标均明显高于化疗前[BW:(42.81±11.37)°和(29.28±8.68)°;SD:(11.65±4.64)°和(8.79±3.14)°;熵:(39.84±5.51)%和(36.19±5.94)%;t=-9.132^-3.173,均P<0.05]。余检测指标差异均无统计学意义(t=-1.161~1.750,z=-1.633^-0.096,均P>0.05)。13例(40.62%,13/32)患者出现化疗后左心室收缩不同步,化疗所致左心室收缩不同步的比例明显高于左心室功能受损的比例(5/32,15.62%;χ^2=4.947,P=0.025);5例化疗所致左心室功能受损者均出现左心室收缩不同步。化疗所致左心室收缩不同步组的LVEF[(54.54±9.25)%]明显低于左心室收缩同步组[(66.79±7.65)%;t=4.087,P<0.01]。结论DLBCL患者蒽环类药物化疗后出现左心室收缩不同步且明显早于左心室功能受损,可作为早期评价蒽环类药物化疗所致心肌损害的指标。Objective To evaluate the left ventricular systolic synchrony and investigate the early diagnostic value of left ventricular systolic dyssynchrony on cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma (DLBCL). Methods Thirty-two patients (22 males, 10 females, age: 22-73(54.4±14.2) years) from June 2016 to January 2019 with confirmed DLBCL and normal gated myocardial perfusion imaging (GMPI) before anthracyclines chemotherapy were enrolled prospectively. GMPI was performed after 6 cycles or more of chemotherapy. Changes of myocardial markers, electrocardiogram (ECG) indicators, left ventricular function indicators including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak filling rate (PFR), summed motion score (SMS) and summed thickening score (STS) as well as left ventricular systolic synchrony indicators including phase bandwidth (BW), phase standard deviation (SD) and entropy before and after anthracyclines chemotherapy were analyzed. Paired t test, Wilcoxon signed rank test and χ^2 test were used for data analysis. Results Compared with pre-chemotherapy, the left ventricular systolic synchrony indicators were significantly higher than those before chemotherapy (BW:(42.81±11.37)° vs (29.28±8.68)°;SD:(11.65±4.64)° vs (8.79±3.14)°;entropy:(39.84±5.51)% vs (36.19±5.94)%;t values:-9.132 to -3.173, all P<0.05). There were no significant differences in other indicators (t values:-1.161 to 1.750, z values:-1.633 to -0.096, all P>0.05). Of 32 patients, 13 patients (40.62%) had left ventricular systolic dyssynchrony, and the rate of chemotherapy-induced left ventricular systolic dyssynchrony was significantly higher than that of left ventricular dysfunction (15.62%, 5/32;χ2=4.947, P=0.025). All 5 patients with left ventricular dysfunction caused by chemotherapy had left ventricular systolic dyssynchrony. The LVEF of the chemotherapy-induced left ventricular systolic dyssynchrony

关 键 词：淋巴瘤 大B细胞 弥漫性 药物疗法 联合 蒽环类 心室功能 左 心肌灌注显像 

分 类 号：R733[医药卫生—肿瘤]