分层应变技术评价左侧早期乳腺癌保乳放疗后左心室收缩功能及同步性改变  

Evaluation of left ventricular systolic function and synchrony in patiests with early left breast cancer after breast conserving radiotherapy by layer-specific strain technique

作　　者：李潜 刘春丽 袁建军[2] 周艳珂 Li Qian;Liu Chunli;Yuan Jianjun;Zhou Yanke(Department of Ultrasound,Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Ultrasound,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学附属肿瘤医院超声科,450008 [2]河南省人民医院超声科,郑州450003

出　　处：《中华超声影像学杂志》2020年第2期125-130,共6页Chinese Journal of Ultrasonography

基　　金：河南省科技攻关计划项目(182102310152)。

摘　　要：目的探讨应用分层应变技术评价左侧早期乳腺癌保乳放疗结束后患者的左室收缩功能及心肌同步性的变化。方法选取2018年1月至2019年1月于郑州大学附属肿瘤医院经手术病理确诊的左侧早期乳腺癌并行保乳放疗患者36例,应用分层应变技术分别于放疗前1周、放疗后1周、放疗后6个月采集二维动态超声心动图,并应用EchoPAC 201软件分析获得左室17节段的心外膜层、中层及心内膜层及整体的纵向应变值(LPSepi,LPSmid,LPSendo,GLPS)及峰值应变离散度(PSD),比较放疗前后各参数的差异性,并分析PSD与其他参数的相关性。结果与放疗前1周比较,放疗后1周LPSepi、LPSmid、LPSendo、GLPS绝对值均减低,PSD增高,差异有统计学意义(P<0.05);放疗后6个月LPS-Epi、LPS-mid、LPS-endo、GLPS绝对值明显减低,PSD明显增高,差异有统计学意义(P<0.05);与放疗后1周比较,放疗后6个月各层LPS及GLPS绝对值明显减低,PSD明显增高,差异有统计学意义(P<0.05)。放疗后1周PSD与GLPS呈负相关(r=-0.420,P<0.05),放疗后6个月PSD与GLPS呈负相关(r=-0.641,P<0.05)。结论分层应变技术能够无创、定量评价左侧早期乳腺癌保乳放疗患者左室心肌分层纵向应变及收缩同步性,为评估放射性心肌损伤提供一种新的无创检测方法,对临床早期干预和治疗心血管并发症发生具有一定的指导意义。Objective To evaluate the left ventricular systolic function and synchronization of patients with early left breast cancer after breast conserving radiotherapy by layer-specific strain technique.Methods Thirty-six patients with early left breast cancer who underwent breast surgery and radiotheraphy in Affiliated Tumor Hospital of Zhengzhou University from January 2018 to January 2019 were selected for this study.The layered strain technique was respectively applied to collect two-dimensional dynamic ultrasonic cardiograms one week before radiotherapy,one week after radiotherapy,and six months after radiotherapy.The EchoPAC 201 software was applied to analyze and obtain the global longitudinal peak strain(GLPS)and peak stain dispersion(PSD)of the epicardial layer(epi),the middle layer(mid)and endocardial layer(endo)of 17 left ventricular segments.The differences of every parameter before and after radiotherapy were compared,and the correlation of PSD and other parameters was analyzed.Results Compared with one week before radiotherapy,the absolute values of LPSepi,LPSmid,LPSendo,and GLPS all reduced significantly one week and six months after radiotherapy,and PSD increased significantly(P<0.05).Compared with one week after radiotherapy,the LPS absolute value of every layer and GLPS obviously reduced after six months,PSD obviously increased,the difference had statistical significance(P<0.05).PSD and GLPS displayed negative correlation one week after radiotherapy(r=-0.420,P<0.05),PSD and GLPS displayed negative correlation six months after radiotherapy(r=-0.641,P<0.05).Conclusions Layered strain technique can noninvasively and quantitatively evaluate the early changes of global and layered longitudinal peak strain and systolic synchrony of left ventricle in left breast cancer breast-conserving radiotherapy patients,and provides a new noninvasive test method for evaluating radioactive myocardial injury,and it has a certain guiding value to early clinical intervention and treatment of cardiovascular complications.

关 键 词：乳腺癌 早期 放射治疗 分层应变 峰值应变离散度 

分 类 号：R737[医药卫生—肿瘤]