左室整体纵向应变在早期预测乳腺癌化疗患者心脏毒性中的应用  

The application of left ventricular global longitudinal strain in predicting early cardiotoxicity in breast cancer patients undergoing chemotherapy

作　　者：闻小林[1] 王玲[1] 陈剑琼[2] 张超学[1] Wen Xiaolin;Wang Ling;Chen Jianqiong;Zhang Chaoxue(Dept of Ultrasound,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Dept of Medical Oncology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院超声医学科,合肥230022 [2]安徽医科大学第一附属医院肿瘤内科,合肥230022

出　　处：《安徽医科大学学报》2023年第3期486-489,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省公益性技术应用研究联动计划项目(编号:1501id04039)。

摘　　要：目的探讨乳腺癌患者化疗后左室整体纵向应变(LVGLS)在早期预测化疗相关心脏毒性中的价值。方法86例乳腺癌患者参与本研究,并接受6个周期多柔比星+环磷酰胺化疗方案。化疗前(T0)、化疗全部结束(T1)以及化疗结束后6个月(T2)和12月(T3)测量常规超声心动图参数;应用二维斑点追踪成像技术(2D-STI)获取LVGLS,计算T1期LVGLS相对变化率(△LVGLS)。以出现心脏毒性为临床结局,绘制受试者工作特征(ROC)曲线分析T1期相关参数,评估△LVGLS在预测心脏毒性中的价值。结果(1)相比化疗前,T1期LVEF轻微下降,但差异无统计学意义(P>0.05);而T2和T3期LVEF减弱明显(P<0.05)。(2)相比化疗前,LVGLS早在T1期即出现下降,T2及T3期LVGLS进一步受损(P<0.05)。(3)化疗期间及化疗结束后随访共有7例患者(8.1%)发生化疗相关心脏毒性。Spearman相关性分析显示T1期LVGLS和△LVGLS均与化疗引发心脏毒性相关,其中△LVGLS相关性较明显(r=0.64,P<0.001)。ROC曲线分析显示T1期△LVGLS>12%预测化疗相关心脏毒性,敏感性92.2%,特异性76%,曲线下面积0.88。结论乳腺癌患者接受多柔比星治疗后,LVGLS减弱早于传统左室射血分数(LVEF),化疗结束后△LVGLS>12%是预测乳腺癌化疗患者出现心脏毒性的良好指标。Objective To investigate the value of left ventricular global longitudinal strain(LVGLS)in predicting early chemotherapy related cardiotoxicity in breast cancer patients after chemotherapy.Methods Eighty-six breast cancer patients were enrolled in this study and received 6 cycles of doxorubicin+cyclophosphamide.Conventional echocardiography parameters were measured before chemotherapy(T0),immediately after chemotherapy(T1),6 months(T2)and 12 months after chemotherapy(T3).LVGLS was obtained by 2D speck tracing imaging(2D-STI),and the relative change of LVGLS(△LVGLS)was calculated at T1.With the occurrence of cardiotoxicity as the clinical outcome,receiver operating characteristic(ROC)curve was plotted.The parameters were analyzed at T1 to evaluate the value of △LVGLS in predicting cardiotoxicity.Results①Although the change in LVEF was not different between T0 and T1(P>0.05),LVEF decreased significantly at T2 and T3(P<0.05).②Compared with T0,LVGLS decreased at T1,which was further damaged at T2 and T3(P<0.05).③Seven patients(8.1%)developed chemotherapy-related cardiotoxicity.LVGLS and△LVGLS were correlated with cardiotoxicity at T1 stage,and△LVGLS was more significant(r=0.64,P<0.001).ROC curve analysis showed that a△LVGLS>12% at T1 predicted cardiotoxicity,with sensitivity of 92.2%,specificity of 76%,and area under the curve was 0.88.Conclusion The LVGLS decreased earlier than LVEF in breast cancer patients after doxorubicin treatment.△LVGLS>12% is a good predictor of cardiotoxicity in patients with breast cancer.

关 键 词：乳腺癌 蒽环类药物化疗 斑点追踪成像 化疗相关心脏毒性 

分 类 号：R445.1[医药卫生—影像医学与核医学]