三维斑点追踪成像技术评估不同剂量蒽环类药物化疗后左心室应变  

Evaluation of left ventriculaRdeformation changes in patients underwent different doses of anthracycline chemotherapy using 3D speckle-tracking imaging

作　　者：韩孟晓 李政 张群岭 王妍 舒先红 程蕾蕾 HAN Mengxiao;LI Zheng;ZHANG Qunling;WANG Yan;SHU Xianhong;CHENG Leilei(School of Health Science and Engineering,University of Shanghai foRScience and Technology,Shanghai 200093,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Medical Oncology,Fudan University Shanghai CanceRCenter,Shanghai 200032,China;Department of Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海理工大学健康科学与工程学院,上海200093 [2]复旦大学附属中山医院心脏超声诊断科,上海200032 [3]上海市影像医学研究所,上海200032 [4]复旦大学附属肿瘤医院肿瘤内科,上海200032 [5]复旦大学附属中山医院肿瘤内科,上海200032 [6]复旦大学附属中山医院心内科,上海200032

出　　处：《中国临床医学》2024年第4期559-564,共6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);上海市卫生健康委员会基金(202040344)。

摘　　要：目的应用超声心动图三维斑点追踪成像(3D speckle-tracking imaging,3D-STI)技术分析评估采用不同剂量蒽环类药物化疗的弥漫大B细胞淋巴瘤(diffuse large B-cell non-Hodgkin lymphoma,DLBCL)患者的左室形变功能变化。方法纳入接受蒽环类药物化疗的DLBCL患者66例。根据接受蒽环类药物的累积剂量,将患者分为高剂量组(>360 mg/m2,n=39)和低剂量组(≤360 mg/m2,n=27)。患者分别于化疗前及全部化疗周期结束后1周内行超声心动图检查,应用3D-STI分析左心室整体纵向应变(left ventriculaRglobal longitudinal strain,LVGLS)、左心室整体环向应变(left ventriculaRglobal circumferential strain,LVGCS)等指标化疗前后的差异,分析不同亚组间的左心应变指标差异及变化率差异。结果与化疗前相比,患者化疗后的LVGLS、LVGCS、左心房纵向应变(left atrial global longitudinal strain,LAGLS)均显著降低(P<0.001)。与低剂量组相比,高剂量组在化疗结束时LVGCS变化率明显增加[21.12(6.52,35.37)vs 5.49(﹣14.73,27.01);P=0.03]。而两亚组之间患者的左室射血分数(left ventriculaRejection fraction,LVEF)、LVGLS、LVGCS、LVEF变化率及LVGLS变化率等参数差异无统计学意义。结论3D-STI在评价肿瘤患者蒽环类药物治疗后,早期左室功能的亚临床改变有一定的临床参考价值;LVGCS变化率可作为预测高低剂量蒽环类药物治疗后心脏功能亚临床变化差别的辅助指标。Objective To analyze the changes in left ventriculaRdeformation function in patients with diffuse large B-cell lymphoma(DLBCL)treated with different doses of anthracycline chemotherapy using 3D speckle-tracking imaging(3D-STI).Methods 66 DLBCL patients receiving anthracycline chemotherapy were enrolled.Based on the cumulative dose of anthracycline received,the patients were divided into a high-dose group(>360 mg/m2,n=39)and a low-dose group(≤360 mg/m2,n=27).Patients underwent transthoracic echocardiography before chemotherapy and within one week afteRcompletion of the entire chemotherapy cycle.Left ventriculaRglobal longitudinal strain(LVGLS),left ventriculaRglobal circumferential strain(LVGCS),and otheRindices were analyzed using 3D-STI to assess changes in left ventriculaRdeformation indices afteRchemotherapy and between two groups.Results Compared to baseline,DLBCL patients showed significant reductions in LVGLS,LVGCS and left atrial global longitudinal strain(LAGLS)afteRtreatment completion(P<0.001).When comparing the high-dose group with the lowdose group,there was a significant increase in relative LVGCS change rate at the end of chemotherapy(21.12[6.52,35.37]vs 5.49[﹣14.73,27.01];P=0.03).However,there were no statistically significant differences in relative left ventriculaRejection fraction(LVEF),LVGLS,LVGCS,LVEF change rate,oRLVGLS change rate between the two groups.Conclusions 3D-STI can be a potential method to identify the sub-clinical deterioration of left ventriculaRsystolic function in patients received anthracycline chemotherapy,the difference of change rate of LVGCS may predict the variation of sub-clinical deterioration of left ventricular function between patients received high and low doses of anthracycline chemotherapy.

关 键 词：肿瘤心脏病 淋巴瘤 三维斑点追踪成像 蒽环类药物化疗 

分 类 号：R541.9[医药卫生—心血管疾病] R733.4[医药卫生—内科学]