超声二维斑点追踪技术联合血清超敏肌钙蛋白检测评价白血病患者蒽环类药物化疗后右心功能早期损害的意义  

Evaluation of Early Right Ventricular Dysfunction in Leukemia Patients with Anthracycline Chemotherapy by Two-dimensional Speckle Tracking Echocardiography Combined with Hs-cTnT

作　　者：尤东华 陈金华[1] 张景发 余小琴[1] 贾保霞[1] 束振华[1] 肖小灵 YOU Donghua;CHEN Jinhua;ZHANG Jingfa;YU Xiaoqin;JIA Baoxia;SHU Zhenhua;XIAO Xiaoling(Shenzhen Longgang Central Hospital,Shenzhen 518116,China;不详)

机构地区：[1]深圳市龙岗中心医院,广东深圳518116

出　　处：《中外医学研究》2021年第12期54-57,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：深圳市龙岗区经济与科技发展专项资金医疗卫生科技计划项目(LGKCYLWS2019000066)。

摘　　要：目的:探讨二维斑点追踪技术(2D-STI)联合血清超敏肌钙蛋白(Hs-cTnT)检测评估白血病患者蒽环类药物化疗后对心脏右心功能早期损害的意义。方法:选取2019年1月-2020年6月年在笔者所在医院确诊的50例急性髓系白血病患者并行蒽环类药物化疗四个周期(T1、T2、T3、T4)者为病例组,并另选50例健康者为对照组。病例组及对照组应用斑点追踪技术选择测量右心室6个节段[侧壁基底段(-Bas)、中间段(-Mid)、心尖段(-Apex);室间隔基底段(-Bas)、中间段(-Mid)、心尖段(-Apex)]的纵向应变值,三尖瓣游离面瓣环收缩期位移(TAPSE)、三尖瓣侧壁瓣环收缩期速度(S)、右心室整体功能指数(RV-Tei),以及E/A、E/E’、RV-Tei指数等各项超声参数;同时采用电化学发光仪检测血清hs-cTnT水平。结果:(1)病例组T1、T2、T3、T4周期化疗后二维斑点追踪技术右心室侧壁-Bas、-Mid、-Apex段,室间隔-Bas、-Mid、-Apex段纵向应变值逐渐减低,T1、T2、T3、T4周期化疗后右心室侧壁-Bas、-Mid段,室间隔-Bas、-Mid段较对照组差异有统计学意义(P<0.05)。(2)病例组T1、T2、T3、T4周期化疗后血清hs-cTnT值分别为(0.010±0.005)、(0.014±0.006)、(0.017±0.011)、(0.019±0.012)ng/ml,较对照组差异有统计学意义(P<0.05)。(3)病例组四个周期化疗后三尖瓣环侧壁收缩期位移(TAPSE)、三尖瓣环侧壁收缩期组织速度(S)与对照组比较差异无统计学意义(P>0.05);病例组在T1、T2、T3、T4周期化疗后E/A、E/E’、RV-Tei逐渐减低或升高,T3、T4周期化疗后右心室E/A参数较对照组降低,E/E’参数较对照组明显增高,RV-Tei较对照组明显增高,与对照组比较差异有统计学意义(P<0.05)。结论:2D-STI技术联合血清hs-cTnT的检测可评估右心室功能受损改变,且二维斑点追踪技术联合血清hs-cTnT的检测早于右心室E/A、E/E’、RV-Tei指数的改变,可作为白血病患者蒽环类药物化疗后右心功能早期损害敏感�Objective:To evaluate the value of 2D-STI combined with Hs-cTnT in evaluating the early damage of right heart function in leukemia patients after Anthracycline chemotherapy.Method:A total of 50 patients with acute myeloid leukemia(AML)diagnosed in our hospital from January 2019 to June 2020 who underwent four cycles of Anthracycline chemotherapy(T1,T2,T3,T4)were selected as the case group.Another 50 healthy subjects were selected as the control group.The Longitudinal strain values of 6 right ventricular lateral wall basal segments(-Bas,-Mid,-APEX),septum basal segments(-Bas,-Mid,-Apex),free tricuspid annulus in systolic phase(TAPSE),lateral tricuspid annulus systolic velocity(S),right ventricular global function index(RV-Tei),E/A,E/E’,RV-Tei and other ultrasonic parameters were measured by speckle tracking technique.The serum levels of hs-cTnT were measured by electrochemiluminescence.Result:(1)The right ventricular lateral wall-Bas,-Mid,-Apex segments and the longitudinal strain values of the right ventricular septum-Bas,-Mid,-Apex segments were gradually decreased in the case group after T1,T2,T3 and T4 cycles of chemotherapy,after T1,T2,T3 and T4 cycles of chemotherapy,right ventricular lateral wall-Bas,-Mid segments,ventricular septal-Bas and-Mid segments showed significant difference(P<0.05).(2)The values of Serum hs-cTnT after chemotherapy in T1,T2,T3 and T4 cycles were(0.010±0.005),(0.014±0.006),(0.017±0.011),(0.019±0.012)ng/ml,respectively.There was significant difference between the two groups(P<0.05).(3)After four cycles of chemotherapy,the systolic displacement(TAPSE)and the systolic tissue velocity(S)of tricuspid annulus had no significant difference between the two groups(P>0.05).After T1,T2,T3,T4 cycles of chemotherapy,E/A,E/E’and RV-Tei in the case group decreased or increased gradually,while the right ventricular E/A parameters decreased and E/E’parameters increased significantly in the case group after T3,T4 cycles of chemotherapy,RV-Tei was significantly higher compared with the contro

关 键 词：二维斑点追踪 血清超敏肌钙蛋白 白血病患者 化疗 右心功能 早期损害 

分 类 号：R733.7[医药卫生—肿瘤]