左心房纵向应变评价HER2阳性乳腺癌患者序贯化疗相关心肌损伤的临床价值  

Evaluation of sequential chemotherapy-related myocardial injury in patients with HER2 positive breast cancer by left atrial longitudinal strain

作　　者：洪玮[1] 吕志红[1] 赵刚[2] 杨银凤 柯建梅 HONG Wei;LYU Zhihong;ZHAO Gang;YANG Yinfeng;KE Jianmei(Department of Ultrasonography,Huangshi Central Hospital,Huangshi 435000,China;不详)

机构地区：[1]黄石市中心医院超声影像科,435000 [2]黄石市中心医院放射影像科,435000

出　　处：《浙江医学》2023年第8期834-839,共6页Zhejiang Medical Journal

基　　金：湖北省自然科学基金创新发展联合基金项目(2022CFD066)。

摘　　要：目的探讨左心房纵向应变参数评价人表皮生长因子受体2(HER2)阳性乳腺癌患者使用蒽环类药物序贯曲妥珠单抗化疗相关心肌损伤的临床价值。方法收集2020年1月至2021年12月黄石市中心医院使用蒽环类药物序贯曲妥珠单抗化疗的HER2阳性乳腺癌患者61例,于化疗前(T_(0)期)、应用蒽环类药物化疗4周期后(T_(1)期)及序贯曲妥珠单抗17周期后(T_(2)期)进行超声心动图检查,记录常规超声参数及二维斑点追踪成像应变参数:左心室射血分数(LVEF)、左心室整体纵向应变(LVGLS)、收缩期左心房峰值应变(LASs)、舒张早期左心房峰值应变(LASe)、心房收缩期左心房峰值应变(LASa),计算LVGLS下降率、LASs下降率。将在T_(2)期出现肿瘤治疗相关心功能障碍(CTRCD)的11例患者列为CTRCD组,未出现CTRCD的50例患者列为无CTRCD组,并比较两组患者上述参数的差异。结果T_(0)期两组间各常规超声参数及应变参数比较差异均无统计学意义(均P>0.05)。CTRCD组患者T_(1)期与T_(0)期比较,LVGLS、LASs、LASe均明显降低(均P<0.05);T_(2)期与T_(0)期比较,LVGLS、LASs、LASe、LASa均明显降低(均P<0.05);T_(2)期与T_(1)期比较,LVGLS、LASs、LASe均明显降低(均P<0.05)。无CTRCD组患者T_(1)期与T_(0)期比较,LVGLS、LASs均明显降低(均P<0.05);T_(2)期与T_(0)期比较LVGLS、LASs、LASe、LASa均明显减低(均P<0.05),T_(2)期与T_(1)期比较LVGLS、LASs均明显降低(均P<0.05)。CTRCD组LASs下降率和LVGLS下降率均明显高于无CTRCD组(均P<0.05)。LASs下降率评价CTRCD的AUC、灵敏度和特异度(AUC为0.835,灵敏度为0.818,特异度为0.800)均高于LVGLS下降率(AUC为0.729,灵敏度为0.808,特异度为0.680)。结论在超声常规参数及应变参数中,左心房纵向应变参数LASs是评价HER2阳性乳腺癌患者蒽环类药物序贯曲妥珠单抗化疗后心肌损伤更敏感的指标。Objective To investigate the clinical value of left atrial longitudinal strain in evaluating myocardial injury associated with sequential chemotherapy in patients with human epidermal growth factor receptor 2(HER2)positive breast cancer.Methods Sixty-one patients with HER2-positive breast cancer who received anthracyclines followed by trastuzumab chemotherapy at Huangshi Central Hospital from January 2020 to December 2021 were enrolled.Echocardiography was performed before chemotherapy(T_(0)),after anthracycline chemotherapy(T_(1)),and after sequential trastuzumab therapy(T_(2)).Conventional ultrasound parameters and two-dimensional strain parameters were recorded:left ventricular ejection fraction(LVEF),left ventricular global longitudinal strain(LVGLS),peak strain of left atrial in systole(LASs),peak strain of left in early diastolic(LASe),peak strain of left in atrial systole(LASa);and the decline rates of LVGLS and LASs were calculated.According to the occurrence of cancer herapeutics-related cardiac dysfunction(CTRCD)at T_(2),patients were divided into CTRCD group(11 cases)and non-CTRCD group(50 cases).Results There were no statistical differences in conventional ultrasonic parameters and strain parameters between the two groups at T_(0)(P>0.05).In CTRCD group,LVGLS,LASs and LASe were significantly reduced at T_(1) compared with those at T_(0)(P<0.05).LVGLS,LASs,LASe and LASa were significantly decreased at T_(2) compared with those at T_(0)(P<0.05).LVGLS,LASs and LASe were significantly reduced at T_(2) compared with T_(1)(P<0.05).In non-CTRCD group,LVGLS,LASs were significantly reduced at T_(1) compared with T_(0)(P<0.05).LVGLS,LASs,LASe and LASa were significantly decreased at T_(2) compared with T_(0)(P<0.05).LVGLS and LASs were significantly decreased at T_(2) stage compared with T_(1)(P<0.05).LASs reduction rate and LVGLS reduction rate in CTRCD group were significantly higher than those in non-CTRCD group(P<0.05).In the evaluation of CTRCD,the area under ROC curve(AUC),sensitivity and specificity of L

关 键 词：左心房 应变 化疗 心功能障碍 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤]