分层应变评价乳腺癌患者调强放射治疗后早期左心室收缩功能  

Evaluation of early left ventricular systolic function after intensity-modulated radiation therapy in breast cancer patients by stratified strain

作　　者：贾育昕 张旭[1] 宋卫平 任卫东[1] JIA Yu-xin;ZHANG Xu;SONG Wei-ping;REN Wei-dong(Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2023年第8期555-559,565,共6页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金项目(编号:81571686)。

摘　　要：目的:评估二维斑点追踪成像(2D-STI)分层应变在乳腺癌患者接受调强放射治疗后早期左室收缩功能不全的临床意义。方法:纳入32例接受胸部调强放射治疗的左侧乳腺癌患者,于放疗前、放疗结束时及放疗结束6周后分别采集超声心动图图像。测量并比较乳腺癌患者放疗前、放疗结束时及放疗结束6周后超声心动图常规参数及2D-STI分层应变参数的差异,并分析其与放射剂量学参数(心脏受照射剂量平均值,MHD)、V5及V20(分别指受到5 Gy、20 Gy以上剂量照射的心脏体积占全心脏总体积的百分比)的相关性。结果:在放疗前、放疗结束和放疗结束6周后,左室射血分数及其它常规超声参数的差异无显著性(P>0.05)。与放疗前比较,放疗结束时心内膜下心肌(GLS-endo)、中层心肌(GLS-mid)及心外膜下心肌(GLS-epi)的绝对值显著减低(均为P<0.05),放疗结束6周后GLS-endo、GLS-mid及GLS-epi的绝对值与放疗前、放疗结束时比较再次减低(均为P<0.05),以GLS-endo减低最为明显,GLS-mid及GLS-epi次之,三者间存在显著性差异(P<0.05)。相关性分析显示ΔGLS-endo%与MHD和V20之间存在线性相关(r值为0.731和0.868,P<0.05),但与V5之间的相关性不显著(P>0.05)。多元线性回归结果表明,V20与ΔGLS-endo%之间存在着独立的相关性(β为0.760,P<0.05),MHD与ΔGLS-endo%之间相关性不显著(P>0.05)。结论:左侧乳腺癌患者接受调强放射治疗后早期左心室三层心肌收缩功能均有不同程度受损,以心内膜下层心肌最为显著,其损伤程度与心脏受辐射剂量存在相关性,放射剂量学参数中V20与ΔGLS-endo%呈独立相关。Objective:To assess the clinical significance of two-dimensional speckle tracking imaging(2D-STI)stratified strain in early left ventricular systolic insufficiency in breast cancer patients treated with intensity-modulated radiation therapy.Method:Thirty-two patients with left-sided breast cancer treated with intensity-modulated radiation to the chest were includ-ed,and echocardiographic images were taken before,at the end of,and 6 weeks after radiotherapy.Echocardiographic param-eters and 2D-STI stratified strain parameters were measured and compared before,at the end of and 6 weeks after radiothera-py,and correlated with radiation dosimetric parameters(mean dose to the heart(MHD),the percentage of total heart volume ir-radiated with doses above 5 Gy and 20 Gy(V5,V20),respectively).Result:The differences in left ventricular ejection fraction and other conventional ultrasound parameters were not significant(P0.05)before,at the end of,and 6 weeks after radiotherapy.The absolute values of GLS-endo,GLS-mid and GLS-epi were significantly reduced at the end of radiotherapy compared with those before radiotherapy(P0.05 for all),and 6 weeks after radiotherapy,the absolute values of GLS-endo,GLS-mid and GLS-epi were again reduced compared with those before and at the end of radiotherapy(P0.05 for all),with the most significant reduction in GLS-endo,GLS-mid and GLS-epi.GLS-endo was the most significant,followed by GLS-mid and GLS-epi,and the difference between the three was significant(P0.05).Correlation analysis showed that there was a linear correlation betweenΔGLS-endo%and MHD and V20(r values of 0.731 and 0.868,P0.05),but the correlation with V5 was not significant(P0.05).Multiple linear regression results showed that there was an independent correlation between V20 andΔGLS-endo%(βof 0.760,P0.05),and the correlation between MHD andΔGLS-endo%was not significant(P0.05).Conclusion:All three layers of left ventricular myocardial systolic function were impaired to varying degrees in patients with left-sided breast canc

关 键 词：乳腺肿瘤 心室功能 左 超声检查 多普勒 彩色 

分 类 号：R737.9[医药卫生—肿瘤] R322.11[医药卫生—临床医学] R445.1