组织多普勒评价胸部放疗对肿瘤患者心脏功能影响的临床研究

Clinical study of tissue Doppler imaging in assessing heart damage induced by chest radiotherapy

目的:探讨常规超声心动图(Echocardiography)和组织多普勒技术(Tissue Doppler Imaging,TDI)在评价胸部放疗对心脏功能影响方面的临床应用价值。方法:将120例患者依据是否联合化疗及化疗剂种类分为单纯放疗组(I),放疗联合蒽环类化疗组(II),放疗联合其它化疗剂组(III)。测定并比较120例胸部肿瘤患者放疗前和放疗后6个月的常规参数及组织多普勒参数。健康志愿者29例,作为平行对照组,记录其在相同的时间间隔内上述参数变化。结果:与放疗前相比,组织多普勒显示房室瓣瓣环及右室游离壁收缩期运动速度峰值、心室舒张早期运动速度峰值比放疗前降低,而心房收缩期运动速度峰值升高。其中,II组上述参数改变比I组和III组更为明显;III组的心脏损害亦较I组为著。仅有34例(28.3%)患者放疗后出现常规左室舒张功能指标异常。12例(10%)患者放疗后出现常规右室舒张功能指标异常。肺动脉高压2例。但左心室收缩功能参数、室间隔(IVS)及左室后壁(LVPW)的室壁增厚率(ΔT);平行对照组在首次检查6月后未发现常规超声心动图检查及组织多普勒参数明显改变。结论:常规超声心动图及组织多普勒技术可用于评价放疗所致的早期心脏功能异常,与常规超声心动图检查相比,TDI技术能更早、更敏感地评价放疗致心脏功能损害。放疗联合应用化疗可加重心脏损害,尤以联合蒽环类化疗剂为重。

Objective： To explore the clinical value of echocardiography and tissue Doppler imaging （TDI） in assessing heart function induced by chest radiotherapy in patients with thoracic tumors. Methods： 120 patients （those patients were divided into three groups： group Ⅰ simple radiotherapy; group Ⅱ radiotherapy combined with Anthracyclines; group Ⅲ radiotherapy combined with other chemotherapeutic drugs） received chest radiotherapy were examined by echocardiography and TDI before radiotherapy and six months after the treatment. Twenty-nine healthy person were enrolled as control group. Results： Parameters of TDI shows： after radiotherapy, the peak motion velocity during systolic period and early diastolic period of mitral annulus, tricuspid annulus and right ventricle free wall decreased, while the peak velocity during atria contraction period increased. Among patients received radiotherapy combined with Anthracyclines the changes of parameters acquired from TDI differed significantly from those patients treated by simplex radiation or radiotherapy combined with other chemotherapeutic drugs. At the same time, those data in patients received radiotherapy combined with other chemotherapeutic drugs differed significantly from those patients treated by simplex radiation. Parameters of left ventricle systolic function index had no statistic significance compared with those data acquired before radiation. Abnormalities of routine diastolic function index of left ventricle appearod in 34 patients （28.3%）,abnormalities of routine diastolic function index of right ventricle appeared in 12 patients （10%） and increased pulmonary artery systolic pressure appeared in 2 patients. As to the control group, all the parameters changed insignificantly six months later. Conclusion： Echocardiography and TDI can be used in assessing early heart damages induced by chest radiotherapy. Compared with echocardiography, TDI are more sensitive in detecting abnormalities of heart function. Radiotherapy combined with Anthracyclines or other chemotherapeutic drugs can aggravate heart damage, especially combined with Anthracyclines.