二维斑点追踪技术对柔红霉素药物急性期心肌损伤的相关性  

Two-dimensional Speckle Tracking Technology in the Study of Acute Myocardial Injury Caused by Anthracyclines

作　　者：闵杰青[1] 田锦润 李霁伟[1] 魏骊铮 王鹏[1] 曹彦洁 何文姬[1] 樊茂[1] 张倩[1] 杨云娟[2] MIN Jieqing;TIAN Jinrun;LI Jiwei;WEI lizheng;WANG Peng;CAO Yanjie;HE Wenji;FAN Mao;ZHANG Qian;YANG Yunjuan(Kunming Children’s Hospital,Kunming Yunnan 650028;Yunnan Disease Prevention and Control Center,Kunming Yunnan 650022,China)

机构地区：[1]昆明市儿童医院,云南昆明650028 [2]云南省疾病预防控制中心,云南昆明650022

出　　处：《昆明医科大学学报》2022年第2期34-38,共5页Journal of Kunming Medical University

基　　金：云南省科学技术厅-昆明医科大学应用基础研究联合专项基金资助项目(201801CH00477);云南省教育厅科学研究基金资助项目(2018JS242)。

摘　　要：目的应用二维斑点追踪技术(STI)研究柔红霉素致滇南小耳猪急性期心肌损伤的左心室应变特点及心肌病理改变。方法选取滇南小耳猪6只,常规给予麻醉后连接心电图电极,予柔红霉素进行静脉推注,制成心脏毒性急性期动物模型,并于给药前和给药后3 d进行心脏超声数据获取、抽血进行cTnT测定,处死后进行心脏、肝脏的病理检测。超声参数获取二维超声心动图测量左心室舒张末期内径(left ventricular enddiastolic diameter,LVDd)、二尖瓣舒张期血流E峰速度、A峰速度及E/A比值、自动计算左心室整体纵向应变GLS、左心室分层纵向应变参数并进行对比分析。结果急性期心肌损伤给药前后左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、室间隔舒张末厚度(IVSd)左室后壁舒张末厚度(PWd),M型测量左心室EF均无统计学差异(P>0.05)。给药后血清cTnT浓度虽然逐步升高,但一直保持在正常范围内,较给药前所测值无明显统计学差异(P>0.05)。肝脏和心肌细胞不同程度出现水肿、充血表现,心内膜出现玻璃样变和粘液样变。给药前后左心室整体和心内膜层的GLS有统计学差异(P<0.05),中间层及心外膜层的GLS无统计学差异(P>0.05)。结论大剂量蒽环类药物对心肌会产生急性期的心肌损伤,病理结果支持心肌细胞的损伤。同时常规测量心腔大小以及EF不能及时反应出心肌的功能损伤,应用2D-STI技术测量左心室纵向应变以及心内膜层中心应变相较于传统心脏超声数据如EF等能够更敏感地发现应用蒽环类药物后的心脏毒性反应。Objective To study the characteristics of left ventricular strain and myocardial pathological changes in acute myocardial injury induced by anthracyclines in Diannan small-ear pigs.Methods Six smalleared pigs from southern Yunnan were selected.After routine anesthesia,electrocardiogram electrodes were connected,daunorubicin was injected intravenously,and an animal model of acute cardiotoxicity was made.The echocardiography was performed before and three days after the administration.Data acquisition,blood draw for cTnT determination,and pathological examination of heart and liver after execution.Obtain two-dimensional echocardiography of ultrasound parameters to measure the left ventricular end-diastolic diameter(LVDd),peak E velocity,peak A velocity and E/A ratio of blood flow during diastole of the mitral valve,and automatically calculate the overall left ventricle longitudinal strain GLS and left ventricular stratified longitudinal strain parameters were compared and analyzed.Results There was no statistical difference in left ventricular end diastolic diameter(LVDd),left ventricular end systolic diameter(LVDs),ventricular septal end diastolic thickness(IVSd)and left ventricular posterior wall end diastolic thickness(PWd)and EF between before and after administration of acute myocardial injury(P>0.05).Although the serum cTnT concentration gradually increased after administration,it remained within the normal range,and there was no significant statistical difference from the value measured before administration.The liver and myocardial cells showed edema and congestion to varying degrees,and hyaloid and mucus-like changes appeared in the endocardium(P>0.05).There were statistical differences in the overall GLS of the left ventricle and the endocardial layer before and after the administration,but there was no statistical difference in the GLS of the middle layer and the epicardial layer(P<0.05).Conclusions Large doses of anthracyclines can cause acute myocardial damage to the myocardium,and the pathological res

关 键 词：斑点追踪 蒽环类药物 柔红霉素 动物 心肌损伤 

分 类 号：R445.1[医药卫生—影像医学与核医学]