血流动力学技术无创评价不同剂量蒽环类药物化疗患者左心室亚临床变化  

No-invasive evaluation of left ventricular subclinical changes using hemodynamic forces in patients with different doses of anthracycline chemotherapy

作　　者：韩孟晓 李政 陈怡帆 张群岭 张健 舒先红 程蕾蕾 Han Mengxiao;Li Zheng;Chen Yifan;Zhang Qunling;Zhang Jian;Shu Xianhong;Cheng Leilei(School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Medical Oncology,Fudan University Shanghai Cancer Center,Shanghai 200032,China)

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

出　　处：《中国心血管杂志》2025年第2期131-137,共7页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金(82470354、82227803);复旦大学附属中山医院科技创新基金(2022ZSCX26);上海市卫生健康委员会科研课题(202040344)。

摘　　要：目的分析血流动力学无创检查对评估接受蒽环类药物化疗的弥漫大B细胞淋巴瘤(DLBCL)患者左心室亚临床变化的价值。方法回顾性研究。纳入2013年10月至2014年3月于复旦大学附属肿瘤医院接受蒽环类药物化疗的DLBCL患者28例。根据化疗剂量,将患者分为高剂量组(蒽环类药物剂量>360 mg/m^(2),16例)和低剂量组(蒽环类药物剂量≤360 mg/m^(2),12例)。患者分别于化疗前和全部化疗周期结束后1周内行超声心动图检查,分析并比较患者化疗前后左心室射血分数(LVEF)、左心室应变指标如左心室整体纵向应变(LVGLS)和左心室整体圆周应变(LVGCS),以及血流动力学(HDF)参数如血流动力学功、左心室长轴压力梯度、左心室短轴压力梯度、左心室长轴脉冲压力梯度、左心室短轴脉冲压力梯度等差异。绘制受试者特征曲线分析左心室长轴压力梯度和左心室长轴脉冲压力梯度对接受大剂量蒽环类化疗患者的诊断效率。采用Pearson相关分析对血流动力学功变化与随访7年后LVEF变化率、LVGLS变化率和LVGCS变化率的相关性进行分析。结果在28例患者中,男性16例(57.1%),平均年龄(52.8±13.3)岁,平均化疗周期(5.56±1.55)个周期。与基线相比,患者化疗后LVEF、LVGCS、LVGLS、血流动力学功、左心室长轴压力梯度、血流动力学比率和左心室长轴脉冲压力梯度差异均有统计学意义(均为P<0.05)。与低剂量组相比,高剂量组化疗后左心室长轴压力梯度和左心室长轴脉冲压力梯度均下降(均为P<0.05)。左心室长轴压力梯度和左心室长轴脉冲压力梯度曲线下面积分别为0.755和0.776,敏感度分别为62.5%和81.3%,特异度分别为83.3%和75.0%。与低剂量组相比,高剂量组随访7年后LVEF和LVGLS变化率均下降(均为P<0.05),且血流动力学功变化率与LVEF变化率和LVGCS变化率均相关(r=-0.42和-0.52,均为P<0.05)。结论HDF对评价蒽环类药物化疗后患者左心�Objective To analyze the value of left ventricular hemodynamic forces(HDF)as a noninvasive tool in evaluating left ventricular subclinical changes in patients with diffuse large B-cell lymphoma(DLBCL)treated with anthracyclines.Methods A retrospective study was conducted.A total of 28 DLBCL patients who received anthracycline chemotherapy in Fudan University Shanghai Cancer Center from October 2013 to March 2014 were included.Patients were divided into high-dose groups(>360 mg/m^(2),16 cases)and low-dose groups(≤360 mg/m^(2),12 cases)based on the cumulative dose of anthracyclines.Patients underwent echocardiography before chemotherapy and within 1 week after all chemotherapy cycles.The differences of left ventricular ejection fraction(LVEF),left ventricular global longitudinal strain(LVGLS)and left ventricular global circumferential strain(LVGCS)and left ventricular HDF parameters including HDF work,HDF strength apex-base,HDF strength iLat-aSep,HDF impulse apex-base,HDF impulse iLat-aSep,HDF ratio and HDF angle were analyzed and compared before and after chemotherapy.The diagnostic efficiency of HDF strength apex-base and HDF impulse apex-base for patients receiving high-dose anthracycline chemotherapy was analyzed by receiver operating characteristic analysis.Pearson correlation analysis was used to analyze the correlation between HDF work change and LVEF change rate,LVGLS change rate and LVGCS change rate after 7 years of follow-up.Results Among the 28 patients,16(57.1%)were males,the mean age was 52.8±13.3 years,and the mean chemotherapy cycle was 5.56±1.55 cycles.There were significant differences in LVEF,LVGCS,LVGLS,hemodynamic work,HDF strength apex-base,HDF strength ratio and HDF impulse apex-base before and after chemotherapy(all P<0.05).After chemotherapy,compared with the low-dose group,HDF strength apex-base and HDF impulse apex-base decreased more significantly in the high-dose group(both P<0.05).The areas under the receiver operating characteristic curve of HDF strength apex-base and HDF impulse

关 键 词：左心室 肿瘤心脏病 淋巴瘤 血流动力学 蒽环类药物 

分 类 号：R541.6[医药卫生—心血管疾病]