左室扭转运动联合高敏肌钙蛋白评估蒽环类药物的早期心肌毒性  

Evaluation of early cardiotoxicity in patients with anthracycline chemotherapy by left ventricular torsion function combined with Hs-cTnT

作　　者：胡莉莉[1] 郑慧[1] 裴静[2] 许芳芳[1] HU Lili;ZHENG Hui;PEI Jing;XU Fangfang(Deprtment of Ultrasound Imaging,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Deprtment of Breast Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院超声科,安徽合肥230022 [2]安徽医科大学第一附属医院乳腺外科,安徽合肥230022

出　　处：《分子影像学杂志》2022年第4期475-479,共5页Journal of Molecular Imaging

基　　金：安徽省公益性研究联动计划项目(1604f0804027);安徽省自然科学基金面上项目(2008085MH295)。

摘　　要：目的应用三维斑点追踪成像技术获取左室扭转运动相关参数联合血清高敏肌钙蛋白(Hs-cTnT),评估乳腺癌术后蒽环类化疗药物早期心肌毒性的发生。方法82例蒽行环类药物化疗的乳腺癌术后患者,于化疗前(Ⅰ组)、化疗2周期(Ⅱ组)、化疗4周期(Ⅲ组)、化疗6周期(Ⅳ组)获取Hs-cTnT、左室扭转运动参数及常规三维参数,比较各参数对于评价早期心肌毒性的敏感度,分析左室扭转运动与Hs-cTnT的相关性。结果4组左室扭转运动参数(左室扭转角度峰值、左室扭矩)依次减低(P<0.05)。左室扭转角度峰值及左室扭矩的曲线下面积分别为0.954、0.912,且具有高特异性和高敏感度。各组血清Hs-cTnT测值小于正常值,但随药物剂量累计而升高(P<0.05);Pearson相关性分析表明,化疗周期中左室扭转运动参数与血清Hs-cTnT浓度呈负相关关系(左室扭转角度峰值:r=-0.467,P<0.001;左室扭矩:r=-0.419,P<0.001)。结论左室扭转运动能够早期监测左室心肌功能的改变,评估蒽环类化疗药物致乳腺癌术后患者的心肌损伤。Objective To evaluate the changes of left ventricular torsion in patients with breast cancer after anthracycline chemotherapy by three-dimensional speckle tracking imaging,and detect the occurrence of early cardiotoxicity,and explore the correlation between left ventricular torsion and high sensitive cardiac troponin T(Hs-cTnT).Methods A total of 82 patients with breast cancer after anthracycline chemotherapy were selected.The parameters of left ventricular torsion and strain function were measured at four time points:before chemotherapy(I),after receiving two cycles(II),four cycles(III)and six cycles(IV).The sensitivity of each parameter to evaluate early cardiotoxicity was compared.then correlation analysis was conducted between Hs-cTnT concentration and left ventricular torsion.Results Comparing the four groups,left ventricular torsion parameters(Ptw,Tor)decreased(P<0.05).The areas under ROC curve of Ptw and Tor were 0.954 and 0.912,they are both with high specificity and sensitivity.After six cycles chemotherapy,the Hs-cTnT was lower than the normal,however,it increased with the dose accumulation of drug during the chemotherapy(P<0.05).Pearson correlation analysis showed that there was a significant negative correlation between the left ventricular torsion and Hs-cTnT concentration in different chemotherapy stages(Ptw:r=-0.467,P<0.001;Tor:r=-0.419,P<0.001).Conclusion Left ventricular torsion can be used as sensitive parameters to evaluate the early cardiotoxicity induced by anthracycline chemotherapy after breast cancer.

关 键 词：蒽环类 三维斑点追踪成像技术 左室扭转 血清高敏肌钙蛋白 

分 类 号：R969[医药卫生—药理学]