实时三维超声心动图与二维斑点追踪技术对PD-1免疫抑制剂诱发早期心肌损伤的评估  

Evaluation of early myocardial injury induced by PD-1 immunosuppressant using real-time three dimensional echocardiography and two-dimensional spot tracking techniques

作　　者：宋焱 耿峰 宛新安 李霞[3] 章春泉[3] Song Yan;Geng Feng;Wan Xin'an;Li Xia;Zhang Chunquan(Department of Cardiac Function&Second Ward of Radiotherapy,Wuhu Hospital Affiliated to East China Normal University(The Second People's Hospital of Wuhu),Wuhu,Anhui 241001,China;Department of Ultrasonography,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330062,China)

机构地区：[1]华东师范大学附属芜湖医院(芜湖市第二人民医院)超声科,安徽芜湖241001 [2]华东师范大学附属芜湖医院(芜湖市第二人民医院)放疗二科,安徽芜湖241001 [3]南昌大学第二附属医院超声科,江西南昌330062

出　　处：《齐齐哈尔医学院学报》2024年第4期348-352,共5页Journal of Qiqihar Medical University

基　　金：安徽省重点研究与开发计划项目(202204295107020064)。

摘　　要：目的 应用实时三维超声心动图(RT-3DE)与二维斑点追踪技术(2D-STI)评估PD-1/PD-L1免疫检查点抑制剂(ICIs)治疗期间患者左室收缩功能变化,探讨其在评估ICIs诱发早期心肌损伤中的应用价值。方法 选择2021年3月—2022年9月在本院接受ICIs治疗的32例肿瘤患者作为研究对象。患者在治疗前(T0)、治疗后1个周期(T1)、2个周期(T2)、3个周期(T3)、4个周期(T4)内进行实验室及经胸超声心动图检查。记录患者治疗前后心脏标记物、左心室常规超声心动图参数、RT-3DE参数变化、2D-STI参数变化。结果 在整个随访期间未观察到心脏标记物、血压、心率、心室腔大小的显著变化。从表中可以看到与T0相比,CK、CK-MB、LDH、BNP在T1~T2时有升高趋势,在T3、T4趋于稳定,差异无统计学意义(P>0.05)。所有研究对象的LVEF均>50%。与T0相比,接受PD-1抑制剂治疗后LVGLS降低,并且在T1~T3期上述变化已明显,T4时显著;T0~T4期间LVGCS差异无统计学意义(P>0.05)。T16-SD/R-R(%)、T16-Dif/R-R(%);T12-SD/R-R(%)、T12-Dif/R-R(%);T6-SD/R-R(%)、T6-Dif/R-R(%)在T1~T3期升高,T4期显著升高,差异有统计学意义(P<0.001)。STI联合RT-3DE是预测免疫抑制剂相关早期亚临床心脏毒性的最佳方法,其诊断敏感性为91.67%,特异性为85%。结论 应用二维斑点追踪与实时三维超声心动图对无明显LVEF降低的ICIs诱发早期心肌损伤具有较高的诊断价值。Objective To evaluate the changes of left ventricular systolic function in patients treated with PD-1/PD-L1 immune checkpoint inhibitors(ICIs) by real-time three-dimensional echocardiography(RT-3DE) and two-dimensional spot tracking(2D-STI),and to explore its application value in the assessment of early myocardial injury induced by ICIs.Methods 32 patients suffering from tumor who received ICIs for treatment in our hospital from March 2021 to September 2022 were included as study subjects.Laboratory and transthoracic echocardiography were performed before treatment(T0),at one cycle(T1),at the second cycle(T2),at the third cycle(T3),and at fourth cycle(T4).The changes of cardiac markers,left ventricular conventional echocardiogram parameters,RT-3DE parameters and 2D-STI parameters were recorded before and after treatment.Results No significant changes in cardiac markers,blood pressure,heart rate,or ventricular chamber size were observed during the entire follow-up period.It can be seen from the table that compared with T0,CK,CK-MB,LDH and BNP showed an increasing trend at T1~T2,and tended to be stable at T3 and T4,with no statistical significance.LVEF of all subjects was over 50%.LVGLS decreased after treatment with PD-1 inhibitors compared with T0,and the above changes were obvious at stage T1~T3,and significantly at T4.There was no significant difference in LVGCS between T0 and T4.T16-SD/R-R(%),T16-Dif/R-R(%);T12-SD/R-R(%),T12-Dif/R-R(%);T6-SD/R-R(%) and T6-Dif/R-R(%) were increased in T1-T3 stage,and significantly increased in T4 stage,with statistical significance(P<0.001).STI combined with RT-3DE was the best method to predict the early subclinical cardiotoxicity associated with immunosuppressants,with a diagnostic sensitivity of 91.67% and specificity of 85%.Conclusions The application of two-dimensional spot tracking and real-time three-dimensional echocardiography has high diagnostic value in the early myocardial injury induced by ICIs without significant decrease in LVEF.

关 键 词：实时三维超声心动图 二维斑点追踪 PD-1免疫抑制剂 心肌损伤 

分 类 号：R540.45[医药卫生—心血管疾病]