超声心动图联合SPECT心肌灌注显像及NT-pro-BNP检测评价胸部放射治疗致心脏损伤的研究  

Application of Doppler echocardiography,SPECT myocardial perfusion imaging and NT-pro-BNP in the evaluation of cardiac injury caused by chest radiotherapy

作　　者：谭瑶[1] 何庆兰 张栋梅 陈晓凤 首峰[2] 周永祥[2] 张松 TAN Yao;HE Qing-lan;ZHANG Dong-mei(Ultrasound Department,The People's Hospital of Jianyang City,Jianyang 641400,China;不详)

机构地区：[1]简阳市人民医院超声科,四川简阳641400 [2]简阳市人民医院肿瘤科,四川简阳641400 [3]遂宁市中心医院超声科,四川遂宁629000

出　　处：《中国医学装备》2022年第12期85-89,共5页China Medical Equipment

基　　金：四川省卫生和计划生育科研课题(16PJ525)“超声心动图结合心肌损伤标记物对食管癌患者放射性心脏病的早期评估”。

摘　　要：目的:探讨多普勒超声心动图联合单光子发射计算机断层扫描(SPECT)心肌灌注显像及氨基末端脑钠肽前体(NTpro-BNP)检测在胸部放射治疗致心脏损伤评价中的应用。方法:选取医院收治的96例胸部肿瘤患者,均采用放射治疗,并于放射治疗前后采用多普勒超声心动图、SPECT心肌灌注显像、心电图等方法检测患者左心室射血分数(LVEF)、左心室短轴缩短率(FS)等常规心脏超声指标;左房室瓣舒张早期最大峰值速度(E峰)、舒张晚期最大峰值速度(A峰)等脉冲式多普勒超声检测指标,计算E峰与A峰比值(E/A);舒张早期左房室瓣环运动速度(Ea峰)、舒张晚期左房室瓣环运动速度(Aa峰)等经组织多普勒超声检测指标,计算Ea峰与Aa峰比值(Ea/Aa),并检测患者血清NT-pro-BNP水平,比较不同检查方法心脏损伤的检出率。结果:所有患者放射治疗后LVEF、FS、E峰、E/A、Ea峰、Ea/Aa等超声心动图指标明显低于放射治疗前(t=9.079,t=5.713,t=3.106,t=7.733,t=8.062,t=7.665;P<0.05),EDV、ESV等SPECT心肌灌注显像指标明显高于放射治疗前,LVEF指标明显低于放射治疗前(t=2.026,t=2.553,t=2.838;P<0.05),血清NT-pro-BNP水平与放射治疗前比较明显升高(t=11.639,P<0.05)。放射治疗后超声心动图联合SPECT心肌灌注检出率为46.88%,明显高于超声心动图、SPECT心肌灌注单项检测(x^(2)=5.629,x^(2)=4.269;P<0.05),而心电图、超声心动图及SPECT心肌灌注联合检出率为48.96%,明显高于超声心动图、SPECT心肌灌注及NT-pro-BNP单项检测(x^(2)=7.056,x^(2)=5.528,x^(2)=14.139;P<0.05)。结论:多普勒超声心动图和SPECT心肌灌注显像均能有效的检出放射治疗后心脏损伤,两者联合后能提高心脏损伤的检出率,NT-pro-BNP虽也能在一定程度检出心脏损伤,但对于提升检出率价值不高。Objective:To investigate the applications of Doppler echocardiography,single photon emission computed tomography(SPECT)myocardial perfusion imaging and N-terminal pro brain natriuretic peptide(NT-pro-BNP)in the evaluation of cardiac injury caused by chest radiotherapy.Methods:A total of 96 patients with thoracic tumors admitted to hospital were selected,and all of them were treated with radiotherapy.Doppler echocardiography,SPECT myocardial perfusion imaging and electrocardiogram were used before and after radiotherapy to detect the conventional cardiac ultrasound indicators included left ventricular ejection fraction(LVEF)and left ventricle fractional shortening(FS),the detection indicators of impulse type of Doppler ultrasound included the maximum peak velocity(E peak)of diastole early stage and the maximum peak velocity(A peak)of diastole end stage of left atrioventricular valve.And then,the ratio of E peak and A peak(E/A)was calculated.The detection indicators of Doppler ultrasound included the velocity of the left atrioventricular cingulum tissue(Ea peak)of diastole early stage and that(Aa peak)of diastole end-stage also were detected,and the ratio of them(Ea/Aa)was further calculated.In addition,the serum NT-proBNP levels of patients were detected,and the detectable rates of different detection methods on cardiac injury were compared.Results:The LVEF,FS,E peak,E/A,Ea peak and Ea/Aa of echocardiographic indicators of patients after radiotherapy were significantly lower than those before radiotherapy(t=9.079,t=5.713,t=3.106,t=7.733,t=8.062,t=7.665,P<0.05),and the end diastolic velocity(EDV)and the end systolic volume(ESV)of SPECT myocardial perfusion imaging of patients after radiotherapy were significantly higher than those before radiotherapy,and the LVEF indicators of former was significantly lower than that before radiotherapy(t=2.026,t=2.553,t=2.838,P<0.05),respectively.Compared with that before radiotherapy,the serum NT-pro-BNP level of patients after radiotherapy significantly increased(t=11.639,P<0.05

关 键 词：多普勒超声心动图 单光子发射计算机断层扫描(SPECT) 心肌灌注 氨基末端脑钠肽前体(NT-pro-BNP) 胸部放射治疗 心脏损伤 

分 类 号：R816.4[医药卫生—放射医学]