分层应变技术评价结直肠癌患者化疗前后左心室功能的变化  

Evaluation of changes in left ventricular function before and after chemotherapy by layer-specific strain analysis

作　　者：刘奎灿[1] 秦文娟[1] 王臻 黄磊[1] 董珊珊[1] 芦桂林[1] LIU Kuican;QIN Wenjuan;WANG Zhen;HUANG Lei;DONG Shanshan;LU Guilin(Department of Ultrasonography,First Affiliated Hospital,School of Medicine,Shihezi University,Shihezi 832008,China;School of Medicine,Shihezi University,Shihezi 832008,China)

机构地区：[1]石河子大学医学院第一附属医院超声医学科,石河子832008 [2]石河子大学医学院,石河子832008

出　　处：《广州医药》2022年第3期7-12,共6页Guangzhou Medical Journal

基　　金：石河子大学自主资助支持校级科研项目(ZZZC202076A);石河子大学青年创新培育人才项目(CXPY202008);石河子大学医学院第一附属医院院级课题(QN201901,QN201919,QN202019)。

摘　　要：目的使用分层应变技术评价以mFOLFOX6化疗的结直肠癌患者左心室功能的变化。方法收集30例病理确诊为结直肠癌患者,各位患者均采用mFOLFOX6(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗方案,以自身对照做研究,分别于化疗前、化疗中期、化疗后期行心脏超声检查,获取常规参数,并采集左心室心尖四腔、三腔、两腔切面、短轴二尖瓣、乳头肌、心尖切面的三维动态图像,获取左心室的心肌心内膜下、中层、心外膜下心肌的纵向应变(GLSendo、GLSmid、GLSepi)及左心室心肌心内膜下、中层、心外膜下圆周应变(GCSendo、GCSmid、GCSepi)的数值,计算△GLS(△GLS=GLSendo-GLSepi),△GCS(△GCS=GCSendo-GCSepi),并比较这些数值的绝对值在化疗前后的变化。结果无论化疗前还是化疗后,各层心肌均有跨壁梯度的存在。与化疗前相比:化疗后各层心肌应变参数的绝对值均降低,GLSendo和GCSendo、ΔGLS下降更为显著(P<0.05),其中,GLSendo的ROC曲线下面积为0.766,P<0.001,选25.3%为诊断界点,灵敏度为83.3%,特异度为70%;ΔGLS的ROC曲线下面积为0.749,P<0.001,选4.1%为诊断界点,灵敏度为76.7%,特异度为73.3%。结论心肌分层应变技术有助于早期发现mFOLFOX6致结直肠癌患者左心室各层心肌功能的变化,GLSendo、ΔGLS是该技术中较为敏感的指标。Objective To evaluate the changes of left ventricular function in patients with colorectal cancer treated with mFOLFOX6 using layer-specific strain analysis. Methods The data of 30 patients with pathologically diagnosed with colorectal cancer were collected. All patients were treated with mFOLFOX6(5-fluorouracil+oxaliplatin+calcium leucovorin) chemotherapy. The self-control study was carried out before, during, and after chemotherapy, and cardiac ultrasound was performed to obtain conventional parameters, and three-dimensional dynamic images of the left ventricular apex four-chamber, three-chamber, two-chamber section, short-axis mitral valve, papillary muscle, and apical sectionare were acquired. The longitudinal strain of the three layer of myocardium(GLSendo、GLSmid、GLSepi) and the circumferential strain of myocardium(GCSendo、GCSmid、GCSepi) were collected, and △GLS(△GLS=GLSendo-GLSepi), △GCS(△GCS=GCSendo-GCSepi) were calculated, and the absolute values of these indexes before and after chemotherapy were compared. Results No matter before or after chemotherapy, there was a transmural gradient in each layer of myocardium. Compared with those before chemotherapy, the absolute values of myocardial strain parameters of each layer were reduced after chemotherapy, and GLSendo and GCSendo and ΔGLS decreased more significantly(P<0.05),while the area under the ROC curve of GLSendo was 0.766, P<0.001.Selecting 25.3% as the diagnostic boundary, the sensitivity was 83.3%, and the specificity was 70%.The area under the ROC curve of ΔGLS was 0.749, P<0.001. Selecting 4.1% as the diagnostic boundary, the sensitivity was 76.7%, and the specificity was 73.3%. Conclusions The myocardial layer-specific strain analysis is helpful for early detection of changes in the myocardial function of the left ventricle, which caused by mFOLFOX6 in patients with colorectal cancer. GLSendo and ΔGLS are sensitive indicators in this technique.

关 键 词：MFOLFOX6 心肌分层应变技术 左心室功能 结直肠癌 

分 类 号：R735.34[医药卫生—肿瘤]