二维斑点追踪成像技术结合心肌做功评价蒽环类药物对乳腺癌患者左心室功能的影响  

Evaluation of the effect of anthracyclines on left ventricular function in breast cancer patients using twodimensional speckle tracking imaging combined with myocardial work

作　　者：苗爱雨 智文祥 周瑾 刘雅静 王宇 常才 MIAO Aiyu;ZHI Wenxiang;ZHOU Jin;LIU Yajing;WANG Yu;CHANG Cai(Department of Medical Ultrasound,Fudan University Shanghai Cancer Center/Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院超声诊断科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2020年第10期806-811,共6页China Oncology

基　　金：国家自然科学基金重点项目(81830058);上海市科学技术委员会引导项目(18411967400);国家自然科学基金(81801701)。

摘　　要：背景与目的:应用二维斑点追踪成像(two-dimensional speckle tracking imaging,2D-STI)结合心肌做功评价蒽环类药物对乳腺癌患者左心室功能的影响。方法:前瞻性选择2019年9月—2020年3月在复旦大学附属肿瘤医院行蒽环类药物治疗的35例乳腺癌患者,分别于化疗前、化疗2个周期后、4个周期后行常规超声心动图检查并获取动态二维图像,同时使用肱动脉袖带血压计测量患者收缩期及舒张期血压值,测量左房内径(left atrial diameter,LAD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、舒张末期室间隔厚度(diastolic interventricular septal depth,IVSD)、左心室舒张末期容积(left ventricular enddiastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、左心室射血分数(left ventricular ejection fraction,LVEF)、二尖瓣口舒张早期峰值流速(early diastolic peak velocity,E峰)、舒张晚期峰值流速(late diastolic tissue velocity,A峰)、二尖瓣环间隔处舒张早期峰值速度(early diastolic tissue velocity,e’),并计算E/A、E/e’;应用EchoPac软件脱机分析,获取左心室整体纵向应变(global longitudinal strain,GLS)、左心室分层纵向应变(GLSendo、GLSmid、GLSepi),以及左心室心肌整体做功指数(global myocardial work index,GWI)、整体有用功(global constructive work,GCW)、整体无用功(global wasted work,GWW)、整体做功效率(global myocardial work efficiency,GWE);并行统计学分析。结果:与化疗前比较,化疗2个周期乳腺癌患者GLSeondo、GLS有所减低,但差异无统计学意义(P>0.05);GWW增加,GWE降低(P<0.05);化疗4个周期后GLS、GLSendo、GWI、GCW、GWE均降低,GWW增加。与化疗2个周期后比较,化疗4个周期后乳腺癌患者GLS、GLSendo、GWI、GCW、GWE降低,GWW增加(P<0.05)。与化疗前比较,化疗4个周期后乳腺癌患者E/e’升高(P<0.Background and purpose:This study aimed to evaluate the effect of anthracyclines on left ventricular function in patients with breast cancer using two-dimensional speckle tracking imaging(2D-STI)combined with myocardial work.Methods:Thirty-five breast cancer patients who received anthracycline chemotherapy were prospectively enrolled in the study from Sep.2019 to Mar.2020 in Fudan University Shanghai Cancer Center.All the patients underwent traditional echocardiography and 2D-STI before and after the completion of two cures(160-180 mg/m^2)and four cures of the regimen(320-360 mg/m^2).The brachial artery cuff blood pressure was also obtained.The basic parameters of two-dimensional ultrasound were obtained and calculated,including left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),diastolic interventricular septal depth(IVSD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),early diastolic peak velocity(E),late diastolic tissue velocity(a’)and early diastolic peak velocity/early diastolic tissue velocity(E/e’).The off-line EchoPac software was used to obtain left ventricular global longitudinal strain(GLS),longitudinal strain of three‐layer myocardium(GLSendo,GLSmid,GLSepi),global myocardial work index(GWI),global constructive work(GCW),global wasted work(GWW)and myocardial work efficiency(GWE).Results:Compared with those before chemotherapy,the GLSendo and GLS of breast cancer patients after two cycles of chemotherapy were reduced,but the difference was not statistically significant(P>0.05);GWW increased while GWE decreased significantly after two cycles of chemotherapy(P<0.05).After four cycles of chemotherapy,GLSendo,GWI,GCW and GWE decreased whereas GWW increased significantly compared with those at baseline and after two cycles of chemotherapy(P<0.05).Compared with before chemotherapy,E/e’increased after four cycles of chemotherapy(P<0.05).There was no sig

关 键 词：超声心动描记 二维斑点追踪成像 心室功能 心肌做功 左 乳腺癌 蒽环类药物 

分 类 号：R737.9[医药卫生—肿瘤]