超声心动图检查评价胸部放疗致肿瘤病人心脏损害的临床价值

ECHOCARDIOGRAPHIC EVALUATION OF HEART DAMAGE CAUSED BY CHEST RADIOTHERAPY

目的探讨常规超声心动图检查评价胸部放疗致心脏损害的临床价值。方法120例放疗病人依据是否联合化疗及化疗剂种类分为单纯放疗组(Ⅰ组),放疗联合蒽环类化疗组(Ⅱ组),放疗联合其他化疗剂组(Ⅲ组)。测定并比较120例胸部肿瘤病人放疗前和放疗后6个月的常规超声心动图参数。结果与放疗前相比,放疗后15例病人(12.5%)常规超声心动图检查示心脏结构和血流动力学参数异常,其中心包积液7例,量少至中;心包壁增厚2例;瓣膜形态改变及反流6例,其中主动脉瓣反流3例,二尖瓣反流2例,主动脉瓣及二、三尖瓣均有反流1例,为轻、中度反流;此15例病人中9例为放疗联合蒽环类化疗。34例(28.3%)病人放疗后出现一项或多项左心室舒张功能指标异常(E/A<1、DT或IVRT延长);12例(10.0%)病人放疗后出现常规右心室舒张功能指标异常。出现肺动脉高压2例。但左心室收缩功能参数和室间隔(IVS)及左心室后壁(LVPW)的室壁增厚率(ΔT%)在放疗前后差异无显著性。结论常规超声心动图可评价放疗所致的心脏结构、功能和血流动力学参数异常。心脏舒张功能比收缩功能更易受辐射影响,且放疗联合化疗可加重心脏损害,尤以联合蒽环类化疗剂为重。

Objective To evaluate the significance of echocardiography in assessing heart damage caused by chest radiotherapy. Methods Patients received thoracic radiation therapy （n= 120） were divided into three groups： those receiving radiotherapy only as group Ⅰ ; those receiving radiotherapy together with anthracyclines as group H ; and those receiving radiotherapy together with other chemotherapeutics as group Ⅲ. Echocardiography was performed six months later after the chest radiotherapy, and the results obtained were compared with that before the chest radiotherapy. Results Abnormal findings appeared in 15 patients after radiation （12. 5%）, which included mild to moderate pericardial effusion （7 patients）, thickening of pericardial wall （2）, deformed heart valves with mild to moderate valvular regurgitation in six patients, in which, aortic valve （3 patients）, mitral （2）, and aortic valve complicated with mitral and tricuspid valves （1）. Of these abnormalities, nine patients were found in group Ⅱ. Regression of diastolic function of left ventricle appeared in 34 patients （28. 3 %） and abnormalities of routine diastolic function index of right ventricle appeared in 12 patients （10.0 %）. Hypertension of pulmonary artery during systolic phase appeared in two patients. Parameters of left ventricle systolic function after radiotherapy did not change significantly compared with those before radiotherapy. Conclusion Echocardiography can be used in assessing the heart damage caused by chest radiotherapy. Compared with systolic function, diastolic function is more easily affected. Radiotherapy combined with chemotherapy can aggravate the heart damage, especially when combined with anthracyclines.