超声二维斑点追踪技术在蒽环类化疗药物心脏毒性监测中的应用价值  

Application value of two-dimensional speckle tracking imaging technique in monitoring cardiac toxicity of anthracycline chemotherapy drugs

作　　者：梁梦婕 金怡 郑哲岚 Liang Mengjie;Jin Yi;Zheng Zhelan(Cardiovascular Ultrasound Center,the First Affiliated Hospital of Zhejiang University,Hangzhou 310000,China;Department of Ultrasound,The First People's Hospital of Wenling,Taizhou 317500,China)

机构地区：[1]浙江大学附属第一医院心血管超声中心,杭州310000 [2]温岭市第一人民医院超声科,台州317500

出　　处：《中华医学超声杂志（电子版）》2019年第10期749-755,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的 应用超声二维斑点追踪成像(2D-STI)技术对白血病患者应用蒽环类(ANTH)药物化疗后的心脏相关生物力学参数进行测量,并探讨2D-STI技术在ANTH化疗药物心脏毒性监测中的应用价值.方法 前瞻性选取2016年9月至2018年6月在温岭市第一人民医院住院治疗的白血病患者55例,另选取正常健康者40例作为对照组.55例白血病患者接受包含ANTH药物的化疗方案连续4个周期后,根据12导联心电图检查结果,将其分为心电图正常组(ANTH-A组)35例,心电图异常组(ANTH-B组)20例.ANTH组和正常对照组均进行常规超声心动图检查,测量相关参数,应用2D-STI技术测量相关生物力学参数,对3组之间的各项参数进行比较,并绘制ROC曲线,分析2D-STI技术及常规超声心动图参数预测心脏收缩功能损害的效能.结果 未进行化疗之前,对照组、ANTH-A组、ANTH-B组的常规超声心动图参数比较,差异均无统计学意义(P均>0.05).化疗4个疗程结束后,ANTH-B组的E/A较对照组、ANTH-A组减低,左心室舒张末期容积(LVEDV)较对照组、ANTH-A组增加,差异均有统计学意义(E/A:t=4.26、3.89,LVEDV:t=3.16、2.64,P均<0.05).ANTH-A组基底段平面纵向心肌应变(bLS)、中间段平面纵向心肌应变(mLS)、心尖段平面纵向心肌应变(aLS)、整体全层纵向应变(GLS)低于对照组,达峰时间离散度(PSD)高于对照组,差异均有统计学意义(t=7.61、8.47、8.92、10.04、9.26,P均<0.01);ANTH-B组bLS、mLS、aLS、GLS低于对照组及ANTH-A组,PSD高于对照组及ANTH-A组,差异均有统计学意义(bLS:t=9.66、8.28,mLS:t=10.46、9.42,aLS:t=12.47、10.82,GLS:t=15.28、11.48,PSD:t=12.62、10.86,P均<0.01).ANTH-A组GLS、整体全层径向应变(GRS)低于对照组,差异均有统计学意义(t=10.04、6.62,P均<0.05);ANTH-B组GLS、GRS、整体全层圆周应变(GCS)低于对照组及ANTH-A组,差异均有统计学意义(GLS:t=15.28、11.48,GRS:t=8.86、7.42,GCS:t=7.72、7.43,P均<0.01).ANTH-A组心尖旋转角�Objective To measure cardiac biomechanical parameters in leukemia patients after chemotherapy with anthracycline(ANTH)drugs by ultrasonic two-dimensional speckle tracking imaging(2D-STI),and to evaluate the value of 2D-STI technique in monitoring cardiac toxicity of ANTH chemotherapy drugs.Methods From September 2016 to June 2018,55 leukemia patients hospitalized in The First People's Hospital of Wenling were selected,and 40 healthy volunteers were selected as controls.The patients with leukemia received four cycles of chemotherapy with a regimen containing an ANTH drug.According to the results of 12-lead electrocardiogram,they were divided into either a normal electrocardiogram group(ANTH-A group,n=35)or an abnormal electrocardiogram group(ANTH-B group,n=20).Routine echocardiography was performed in the two groups to obtain conventional echocardiographic parameters,and the related biomechanical parameters were also measured by 2D-STI technique.The parameters of the three groups were compared,and the ROC curve was drawn to analyze the efficiency of 2D-STI technique and conventional echocardiography in predicting cardiac systolic function damage.Results There was no significant difference in conventional echocardiographic parameters among the control group,ANTH-A group,and ANTH-B group before chemotherapy(P>0.05).After four cycles of chemotherapy,E/A in the ANTH-B group was significantly lower than that in the control group and ANTH-A group(t=4.26,3.89,P<0.05),and left ventricular end-diastolic volume(LVEDV)significantly was higher in the ANTH-B group than in the control group and ANTH-A group(t=3.16,2.64,P<0.05).Basal segment longitudinal strain(bLS),middle segment longitudinal strain(mLS),apical segment longitudinal strain(aLS),and global longitudinal strain(GLS)were significantly lower and peak strain dispersion(PSD)was significantly higher in the ANTH-A group than in the control group(t=7.61,8.47,8.92,10.04,9.26,P<0.01).The bLS,mLS,aLS,and GLS were significantly lower and PSD was significantly higher in the AN

关 键 词：超声心动描记术 二维斑点追踪成像 蒽环类 心脏毒性 

分 类 号：R54[医药卫生—心血管疾病]