心肌摄取99Tcm-MIBI相对定量值和血清cTnI检测对蒽环类化疗药物心脏毒性的预测价值  

The Predictive Values of cTnI and Myocardial Relative Quantity of 99Tcm-MIBI for Monitoring the Anthracycline Cardiotoxicity

作　　者：黄剑全 苏新辉[2] 余李娟 黄丽玲 郑钰萍 HUANG Jian-quan;SU Xin-hui;YU Li-juan;HUANG Li-ling;ZHENG Yu-ping(Department of Nuclear Medicine,the Second Hospital of Sanming in Fujian Province,Sanming 366000,China;Department of Nuclear Medicine,Zhongshan Hospital Xiamen University,Xiamen 361004,China)

机构地区：[1]福建省三明市永安总医院核医学科,福建三明366000 [2]厦门大学附属中山医院核医学科,福建厦门361004

出　　处：《标记免疫分析与临床》2019年第10期1642-1645,共4页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金项目(编号:81571707)

摘　　要：目的探讨心肌摄取^99 Tc^m-MIBI相对定量值(MRQ)和血清心肌肌钙蛋白I(cTnI)的检测在监测蒽环类化疗药物对心脏毒性中的预测价值。方法乳腺癌患者37例接受蒽环类药物化疗,在化疗前2 d及化疗后第1、2、4个疗程结束次日采血测定血清心肌肌钙蛋白I(cTnI)水平和行^99 Tc^m-MIBI心肌灌注断层显像,计算左室射血分数(LVEF)和心肌摄取^99 Tc^m-MIBI相对定量值(MRQ),分析血清cTnI、LVEF和MRQ在化疗前后的变化。结果蒽环类药物化疗第1周期后,患者cTnI的水平为0.05±0.02ng/mL,较化疗前略有升高,但差异无统计学意义(P>0.05);第2周期后,cTnI水平为0.08±0.04ng/mL,较化疗前明显升高,差异有统计学意义(P<0.05);第4周期化疗后,cTnI水平为0.11±0.05ng/mL,较化疗前进一步升高(P<0.05)。与化疗前比较,第1周期后,心肌摄取^99 Tc^m-MIBI相对定量值明显下降[MRQ为(50.81±9.29)%,P<0.05],第4周期化疗后进一步下降[MRQ为(45.13±8.73)%,P<0.05],MRQ值的减低主要分布在前间壁、前壁和下壁;而患者第1、2、4周期化疗后的LVEF值无明显变化,差异均无统计学意义(P>0.05)。结论心肌摄取^99 Tc^m-MIBI相对定量值的变化能早期监测蒽环类药物所致的心肌损害,且较左室射血分数灵敏,优于血清cTnI检测,联合血清cTn-I检测,有利于指导蒽环类药物的临床应用。Objective To investigate the clinical values of cardiac troponin I(cTnI)and myocardial relative quantity(MRQ)of 99 Tc^m-MIBI for early monitoring the cardiotoxicity induced by anthracycline.Methods 37 patients with breast cancer who received chemotherapy with anthracyclines were collected for the study.Serum cTnI level,left vent regular ejection fraction(LVEF)and myocardial relative quantity(MRQ)by 99 Tc^m-MIBI myocardial perfusion tomography were determined before the chemotherapy and at the end of the next day of the first,second and fourth course of the treatment.Results The cTnI level after the first cycle of chemotherapy was 0.05±0.02 ng/mL,which was slightly higher than that of pre-chemotherapy,with 0.03±0.01 ng/mL,but with no significant difference(P>0.05).After the second cycle of chemotherapy,the cTnI level was 0.08±0.04 ng/mL,which was significantly higher than that of pre-chemotherapy(P<0.05).After the fourth cycle of chemotherapy,the cTnI level was 0.11±0.05μg/L,which was further higher than that of pre-chemotherapy(P<0.05).The MRQ after the first cycle of chemotherapy(50.81±9.29)%was significantly lower than that of pretherapy(62.43±11.32)%(P<0.01).The MRQ significantly decreased after the fourth cycle of chemotherapy(45.13±8.73)%(P<0.01).Most of the decreased MRQ were distributed in the anterior,anterior and inferior walls.There was no significant difference in LVEF between before and after the chemotherapy(P>0.05).Conclusion Myocardial relative quantity(MRQ)by 99 Tc^m-MIBI myocardial perfusion tomography can facilitate the early monitor of the anthracycline cardiotoxicity,and is more sensitive than LVEF′s which is superior to cTnI.Combined cTnI with 99 Tc^m-MIBI myocardial perfusion tomography could be useful to evaluate early cardiac toxicity of anthracycline chemotherapy for patients.

关 键 词：心肌肌钙蛋白I ^99 Tc^ m-MIBI 发射型计算机断层扫描仪 蒽环类药物 化疗 心脏毒性 

分 类 号：R54[医药卫生—心血管疾病]