斑点追踪技术监测低剂量蒽环类药物对乳腺癌新辅助化疗患者的心脏毒性  

Dynamic evaluation of cardiotoxicity of low dose anthracycline in breast cancer patients during neoadjuvant chemotherapy using two-dimensional speckle tracking imaging

作　　者：谭雪莹 张晶[1] 任卫东[1] 张昕彤 杨洋 Tan Xueying;Zhang Jing;Ren Weidong;Zhang Xintong;Yangyang(Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004,China;Qiqihar Tuberculosis Control Institute,Qiqihar 161000,China)

机构地区：[1]中国医科大学附属盛京医院超声科,沈阳110004 [2]齐齐哈尔市结核病防治院,161000

出　　处：《中华医学超声杂志（电子版）》2021年第2期143-149,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金项目(81571686)。

摘　　要：目的应用二维斑点追踪成像(2D-STI)技术评价接受低剂量蒽环类药物治疗的乳腺癌新辅助化疗患者的左心室收缩功能。方法选取2018年12月至2020年3月在中国医科大学附属盛京医院应用低剂量蒽环类药物行新辅助化疗的乳腺癌患者49例为化疗组,选取25例与化疗组相匹配的健康志愿者作为对照组。在每次化疗前(t0~t5)、最终手术前(t6)行超声心动图检查,获得常规超声心动图参数。应用Qlab软件对图像进行追踪分析,获得整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS);心尖扭转角度峰值(AP-Prot)、心底扭转角度峰值(MV-Prot)、左心室整体扭转角度峰值(LV-Tw)。对化疗组化疗前(t0)与对照组各参数、化疗组不同时间点(t0~t6)各参数的差异进行分析比较。结果化疗组在化疗前(t0)与对照组左心室各参数比较无明显差异;常规超声心动图参数E/A、左心室射血分数、E/e'在化疗期间较晚发生减低,其中LVEF在t4出现减低,在t0~t6分别为62.4%±2.0%、 62.4%±2.0%、 62.3%±2.1%、 62.0%±2.0%、 61.6%±1.8%、61.1%±1.7%、60.2%±1.8%(F=13.533,P<0.05),t4与t0及t3两两比较的平均值差值分别为0.857和0.548(均P<0.05)。应变参数GLS、GCS、GRS呈下降趋势,GLS最早在t1开始降低,在t0~t6分别为-22.0%±1.4%、-21.8%±1.4%、-21.1%±1.4%、-20.0%±1.0%、-19.3%±1.1%、-18.7%±1.2%、-18.1%±1.2%(F=62.473,P<0.05),t1与t0比较的平均值差值为0.224(P<0.05);扭转参数MV-Prot的绝对值在t0~t6无明显变化(P>0.05),AP-Prot和LV-Tw的绝对值均在t1出现降低,以APProt最明显(t1 vs t0:P<0.05)。结论 2D-STI监测新辅助化疗期间低剂量蒽环类药物导致的心脏毒性具有重要价值,GLS和AP-Prot是最敏感的指标。Objective To investigate the value of two-dimensional speckle tracking imaginein detecting the myocardial dysfunction of the left ventriclein patients with breast cancer during neoadjuvant chemotherapy with anthracyclines(ANT).Methods A total of 49 female patients who received ANT treatment(ANT group)at Shengjing Hospital of China Medical University from December 2018 to March2020 and 25 healthy volunteers(control group)were collected.Echocardiography was performed before every episode of chemotherapy(t0-t5)and before surgery(t6)to obtain routine echocardiographic parameters.Speckle tracking software was used to analyze the general parameters,including global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),apical peak rotation(AP-Prot),mitral valvular peak rotation(MV-Prot),and left ventricular twist(LV-Tw).Parameters were compared among different timepoints and between the two groups.Results There was no significant difference in left ventricular parameters between the ANT group(t0)and the control group.The general echocardiography parameters E/A,left ventricular ejection fraction(LVEF),and E/e’decreased,among which LVEF decreased significantly at t4.LVEF values were 62.4%±2.0%,62.4%±2.0%,62.3%±2.1%,62.0%±2.0%,61.6%±1.8%,61.1%±1.7%,and 60.2%±1.8%at t0 to t6,respectively(F=13.533,P<0.05),and the mean difference between t4 and t0 and between t4 and t3 was 0.857 and 0.548,respectively(P<0.05 for both).The strain parameters including GLS,GCS,and GRS showed a downward trend.GLS began to decrease at t1,and it was-22.0%±1.4%,-21.8%±1.4%,-21.1%±1.4%,-20.0%±1.0%,-19.3%±1.1%,-18.7%±1.2%,and-18.1%±1.2%at t0 to t6,respectively(F=62.473,P<0.05),and the mean difference between t1 and t0 was 0.224(P<0.05).The absolute value of torsion parameter MV-prot did not change significantly.The absolute values of AP-prot and LV-TW decreased at t1.AP-prot decreased most obviously(t1 vs t0:P<0.05).Conclusion Speckle tracking imaging is of great value in monitoring the cardiotoxicity ca

关 键 词：乳腺肿瘤 斑点追踪 左心室功能 二维应变 扭转 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]