斑点追踪超声心动图联合心脏血清生物标志物评估乳腺癌患者化疗期间心脏毒性的价值  

Value of Speckle-Tracking Echocardiography Combined with Cardiac Serum Biomarkers in Evaluating Cardiotoxicity During Chemotherapy in Breast Cancer Patients

作　　者：邹文娟 王志兰 李红莲 杨帆 翁昌梅 陈芳 ZOU Wenjuan;WANG Zhilan;LI Honglian;YANG Fan;WENG Changmei;CHEN Fang(Department of Ultrasound,Nanping First Hospital Affiliated to Fujian Medical University,Nanjing 353000,China;Department of Thyroid and Breast Surgery,Nanping First Hospital Affiliated to Fujian Medical University,Nanjing 353000,China)

机构地区：[1]福建医科大学附属南平第一医院超声科,南平353000 [2]福建医科大学附属南平第一医院甲乳外科,南平353000

出　　处：《中国医药指南》2024年第22期1-5,共5页Guide of China Medicine

基　　金：南平市自然科学基金联合资助项目(N2021J019)。

摘　　要：目的探究斑点追踪超声心动图(STE)联合超敏肌钙蛋白(hs-cTnI)、N末端B型利钠肽原(NT-proBNP)评估乳腺癌患者化疗期间心脏毒性的价值。方法选取南平市第一医院2021年9月至2023年8月收治的乳腺癌患者90例,采取蒽环类药物化疗,化疗前(T0)及化疗第2周期(T1)、4周期(T2)、6周期结束(T3)的24 h内行常规超声心动图及STE,根据是否发生心脏毒性分为观察组16例(出现心脏毒性)和对照组74例(无心脏毒性),比较两组化疗期间左心室射血分数(LVEF)、左心室收缩期整体纵向应变(LVGLS)、右心室游离壁应变(RVFWS)及血清hs-cTnI、NT-proBNP水平,分析STE参数联合hs-cTnI、NT-proBNP对乳腺癌患者心脏毒性的诊断价值。结果对照组化疗期间LVGLS、RVFWS无显著变化(P>0.05);观察组T1、T2、T3时的LVGLS、RVFWS均较T0时降低,且均低于对照组同一周期的各STE参数(P<0.05);T3时两组患者LVEF均较T0时降低,且观察组低于对照组(P<0.05);化疗后,两组患者血清hs-cTnI及NT-proBNP均较化疗前升高(P<0.05),且观察组高于对照组(P<0.05);观察组化疗前后STE参数变化幅度(△LVGLS、△RVFWS)、LVEF变化幅度(△LVEF)、血清学指标变化幅度(△hs-cTnI、△NT-proBNP)均高于对照组(P<0.05);乳腺癌患者化疗前后△LVGLS、△RVFWS、△hs-cTnI、△NT-proBNP均与△LVEF呈正相关(r=0.435、0.412、0.513、0.476,P<0.05);△LVGLS、△RVFWS、△hs-cTnI、△NT-proBNP及四者联合诊断乳腺癌患者心脏毒性的曲线下面积(AUC)分别为0.816、0.874、0.818、0.789、0.924,联合诊断效能最高(P<0.05)。结论STE联合hs-cTnI、NT-proBNP能及早判断乳腺癌患者化疗期间心脏毒性情况,可为临床及时调整化疗方案提供参考依据。Objective To explore the value of Speckle-tracking echocardiography(STE)combined with hypersensitive troponin(hs-cTnI)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)in evaluating cardiotoxicity during chemotherapy in breast cancer patients.Methods A total of 90 patients with breast cancer admitted to Nanping First Hospital from September 2021 to August 2023 were treated with anthracycline chemotherapy.Routine echocardiography and STE were performed before chemotherapy(T0),the second cycle(T1),the fourth cycle(T2),and the end of the sixth cycle(T3)within 24 hours.According to whether cardiotoxicity occurred,patients were divided into observation group(16 cases with cardiotoxicity)and control group(74 cases without cardiotoxicity).Left ventricular ejection fraction(LVEF),left ventricular systolic global longitudinal strain(LVGLS),right ventricular free wall strain(RVFWS)and serum hs-cTnI and NT-proBNP levels were compared between the two groups during chemotherapy.To analyze the diagnostic value of STE parameters combined with hs-cTnI and NT-proBNP in cardiotoxicity of breast cancer patients.Results There were no significant changes in LVGLS and RVFWS in control group during chemotherapy(P>0.05).LVGLS and RVFWS in the observation group at T1,T2 and T3 were lower than those at T0,and STE parameters were lower than those in the control group at the same period(P<0.05).At T3,LVEF in both groups was lower than that at T0,and observation group was lower than control group(P<0.05).After chemotherapy,serum hs-cTnI and NT-proBNP in 2 groups were higher than those before chemotherapy(P<0.05),and observation group was higher than control group(P<0.05).The changes of STE parameters(△LVGLS,△RVFWS),LVEF(△LVEF)and serological indexes(△hs-cTnI,△NT-proBNP)before and after chemotherapy in observation group were higher than those in control group(P<0.05).For breast cancer patients,△LVGLS,△RVFWS,△hs-cTnI,△NT-proBNP were positively correlated with△LVEF before and after chemotherapy(r=0.435,0.412,0.513,0.47

关 键 词：乳腺癌 斑点追踪超声心动图 超敏肌钙蛋白 N末端B型利钠肽原 化疗 心脏毒性 

分 类 号：R737.9[医药卫生—肿瘤] R540.45[医药卫生—临床医学]