三维斑点追踪技术评价含曲妥珠单抗化疗方案对HER-2阳性乳腺癌患者左室功能的影响

Assessment of the effect of anthracycline chemotherapy combined with trastuzumab on left ventricular function in HER2-postive breast cancer patients by three-dimensional speckle tracking echocardiography

目的应用三维斑点追踪(3D-STE)技术评价含曲妥珠单抗化疗方案对HER-2阳性乳腺癌患者左室功能的影响。方法选取我院65例乳腺癌术后患者,均采用AC-D-T化疗方案进行治疗,21 d为1个治疗周期。根据治疗过程分为:第0周期,乳腺癌术后,未化疗;第1~4周期(表柔比星+环磷酰胺);第5~8周期(多西他赛+曲妥珠单抗);第9周期(单独使用曲妥珠单抗)。分别于各化疗周期末应用常规超声获取左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、舒张末室间隔厚度(IVSTd)、左室下侧壁厚度(PWTd)、二尖瓣口舒张早期与晚期峰值血流速度比值(E/A)、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)及左室射血分数(LVEF);3D-STE获取左室射血分数(LVEF)、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV),以及整体纵向应变(GLS)、整体面积应变(GAS)、整体径向应变(GRS)、整体圆周应变(GCS);比较各化疗周期末上述超声参数情况。结果各化疗周期常规超声参数比较差异均无统计学意义。各化疗周期3D-STE所测LVEDV、LVESV、LVEF比较,差异均无统计学意义;第4~9周期与第0周期,第8~9周期、第0~3周期与第4周期,第0~4周期与第8周期,第0~7周期与第9周期GLS、GAS比较,差异均有统计学意义(均P<0.05);各化疗周期间GCS、GRS两两比较差异均无统计学意义。结论应用3D-STE技术可以敏感评价含曲妥珠单抗AC-D-T化疗方案对HER-2阳性乳腺癌患者左室功能的影响。

ObjectiveTo investigate the effect of anthracycline chemotherapy combined with trastuzumab on leftventricular function in HER2-postive breast cancer patients by three-dimensional speckle tracking echocardiography(3 D-STE).MethodsSixty-five HER2-postive breast cancer patients treated with AC-D-T chemotherapy with 21 d as a cycle wereenrolled. The cycles of themotherapy were:In the 0 cycle,chemotherapy wasn’t applied after surgery. Epirubicin(Epi)andcyclophosphamide were given in the 1~4 cycle of chemotherapy. Docetaxel and trastuzumab were given in the 5~8 cycle ofchemotherapy. Trastuzumab was only given in the 9 cycle of chemotherapy. At the end of each cycle,the conventionalechocardiographic and 3 D-STE parameters were measured,including the left ventricular end-diastolic diameter(LVDd),leftventricular end-systolic diameter(LVDs),interventricular septum diastolic thickness(IVSTd),posterior wall diastolic thickness(PWTd),the ratio of transmitral peak early to late diastolic velocity(E/A),the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and LV ejection fraction(LVEF).3 D-STE parameters including LVEDV,LVESVand LVEF,left ventricle global longitudinal strain(GLS),globalradial strain(GRS),global circumferential strain(GCS)andglobal area strain(GAS).The parameters of each cycle were compared.ResultsThe conventional echcardiographic parametersand 3 D-STE parameters LVEDV,LVESV,LVEF had no significantly difference among all cycles of chemotherapy.The GLSand GAS had significant difference compared between 4~9 cycle and 0 cycle,8~9 cycle,0~3 cycle and 4 cycle,0~4 cycleand 8 cycle,0~7 cycle and 9 cycle of chemotherapy,respectively(all P<0.05).There were no significant differences of GRS,GCSin all cycles of chemotherapy.Conclusion3 D-STE could sensitively evaluate the effect of AC-D-T chemotherapy on leftventricular function in HER2-postive breast cancer patients.