斑点追踪成像技术评估联合免疫检查点抑制剂、曲妥珠单抗及化疗对HER2阳性晚期胃腺癌患者心功能的影响  

Speckle tracking imaging technique evaluates the impact of combined immune checkpoint inhibitors,trastuzumab,and chemotherapy on cardiac function in patients with advanced HER2-positive gastric adenocarcinoma

作　　者：孜比热·甫拉提 刘雯 陈海燕 王妍 舒先红 程蕾蕾 ZIBIRE Fulati;LIU Wen;CHEN Haiyan;WANG Yan;SHU Xianhong;CHENG Leilei(Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心脏超声诊断科,上海200032 [2]复旦大学附属中山医院肿瘤内科,上海200032

出　　处：《中国临床医学》2024年第4期537-543,共7页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(82170359);上海申康医院发展中心市级医院诊疗技术推广及优化管理技术规范化管理和推广项目(SHDC22023207);中国医学科学院中央级公益性科研院所基本科研业务费专项基金(2024-JKCS-28).

摘　　要：目的评估联合免疫检查点抑制剂、曲妥珠单抗及化疗对人表皮生长因子受体2(HER2)阳性晚期胃腺癌患者心脏左室、右室功能的影响。方法共纳入25例行HER2-ASTRUM治疗(斯鲁利单抗联合曲妥珠单抗及DOS方案)的晚期HER2阳性胃腺癌患者,在基线(T1)、完成4个周期(T2)及6个周期(T3)化疗后接受超声心动图检查,并进一步分析左室应变、左室心肌做功、右室应变及射血分数等指标。结果与T1相比,T2及T3的左室射血分数(left ventricular ejection fraction,LVEF)均降低[T1、T2及T3的LVEF分别为(67.3±2.7)%、(63.0±2.9)%和(61.3±3.2)%;P<0.05];T3的右室射血分数(right ventriculaRejection fraction,RVEF)降低[(59.3±7.8)%vs(43.7±6.6)%,P<0.05],而T2的RVEF无明显变化;右室整体纵向应变(right ventriculaRglobal longitudinal strain,RVGLS)[T1、T2及T3分别为(﹣25.7±5.7)%、(﹣22.4±5.3)%和(﹣19.1±3.6)%;P<0.05]及右室游离壁纵向应变(right ventriculaRfree-wall longitudinal strain,RVFWLS)[T1、T2及T3分别为(﹣20.9±4.7)%、(﹣18.9±4.1)%和(﹣16.1±3.9)%;P<0.05]也均降低。心肌做功指数(global work index,GWI)在T2及T3均低于T1(P<0.05),而整体有效功(global constructive work,GCW)、整体无效功(global wasted work,GWW)、整体做功效率(global work efficiency,GWE)变化差异无统计学意义。结论联合曲妥珠单抗、免疫检查点抑制剂及化疗对HER2阳性晚期胃腺癌患者的左心应变、LVEF及右心应变、GWI均有影响,且左室整体纵向应变、RVFWLS及RVGLS能更灵敏地监测心脏功能,及时发现肿瘤治疗相关的心脏功能障碍。Objective To evaluate the effects of combining immune checkpoint inhibitors,trastuzumab,and chemotherapy on the left and right ventriculaRfunction in patients with advanced gastric adenocarcinoma expressing human epidermal growth factoRreceptoR2(HER2).Methods 25 patients with advanced HER2-positive gastric adenocarcinoma who received HER2-ASTRUM therapy(sruili monoclonal antibody combined with trastuzumab and DOS regimen)underwent echocardiographic examinations at baseline(T1),afteRcompletion of 4 cycles(T2),and 6 cycles(T3)of chemotherapy.Left ventriculaRstrain,left ventriculaRmyocardial work,right ventriculaRstrain,and ejection fraction were furtheRanalyzed.Results Compared with T1,both T2 and T3 showed a decrease in left ventriculaRejection fraction(LVEF),(T1,T2,and T3 were[67.3±2.7]%,[63.0±2.9]%and[61.3±3.2]%,P<0.05).T3 showed a decrease in right ventriculaRejection fraction(RVEF),([59.3±7.8]%vs[43.7±6.6]%,P<0.05),while T2 showed no significant change in RVEF.Both right ventriculaRglobal longitudinal strain(RVGLS),(T1,T2,and T3 were[﹣25.7±5.7]%,[﹣22.4±5.3]%and[﹣19.1±3.6]%,respectively;P<0.05)and right ventriculaRfree-wall longitudinal strain(RVFWLS),(T1,T2,and T3 were[﹣20.9±4.7]%,[﹣18.9±4.1]%and[﹣16.1±3.9]%,P<0.05)decreased in all three time points.The global work index(GWI)was loweRin T2 and T3 than in T1(P<0.05),while the global constructive work 538 Chinese Journal of Clinical Medicine,2024,Vol.31,No.4中国临床医学2024年8月第31卷第4期(GCW),global wasted work(GWW),and global work efficiency(GWE)did not show significant changes.Conclusions Combination of trastuzumab,immune checkpoint inhibitors,and chemotherapy has an impact on left ventriculaRstrain,LVEF,and right ventriculaRstrain,as well as GWI,in HER2-positive patients with gastric adenocarcinoma.Left ventriculaRglobal longitudinal strain(LVGLS),RVFWLS,and RVGLS can more sensitively monitoRcardiac function and detect cardiac dysfunction related to canceRtreatment in a timely manner.

关 键 词：胃癌 免疫检查点抑制剂 曲妥珠单抗 斑点追踪显像技术 超声心动图 肿瘤心脏病 

分 类 号：R735.2[医药卫生—肿瘤] R541[医药卫生—临床医学]