组织多普勒评价蒽环类和非蒽环类化疗药物对肿瘤病人左心室功能的影响

ASSESSMENT OF EFFECTS OF ANTHRACYCLINE OR NO-ANTHRACYCLINEN ON LEFT VENTRICULAR FUNCTION OF PATIENTS WITH MALIGNANCY VIA TISSUE DOPPLER IMAGING

目的探讨组织多普勒技术（TDI）在评价蒽环类药物（ATC）对肿瘤病人左心室功能早期损害方面的临床应用价值。方法50例肿瘤病人依据是否应用ATC化疗分为ATC化疗组（Ⅰ组）26例,非ATC化疗组（Ⅱ组）24例。测定并比较化疗前和化疗后6个月的常规超声心动图参数及组织多普勒参数。结果组织多普勒显示化疗后Ⅰ、Ⅱ组二尖瓣瓣环之心室舒张早期运动速度峰值（Em）均较化疗前有明显降低（t=3.01、2.23,P〈0.01、0.05）,心房收缩期运动速度峰值（Am）均较化疗前明显升高（t=2.96、2.16,P〈0.01、0.05）,Em/Am均较化疗前明显降低（t=2.81、2.09,P〈0.01、0.05）;Ⅰ组收缩期运动速度峰值（Sm）较化疗前明显减低（t=2.43,P〈0.05）,但Ⅱ组Sm化疗前后差异无显著性（t=2.00,P〉0.05）;化疗后Ⅰ组TDI参数值变化与Ⅱ组比较差异有显著性（t=2.03-2.08,P〈0.05）;但射血分数（EF）、短轴缩短率（FS）等常规左心室短轴收缩功能参数在化疗前后差异无显著性（t=1.99-2.03,P〉0.05）,仅有13例（26%）病人出现常规左心室舒张功能指标异常。结论TDI技术能更早、更敏感地评价ATC对肿瘤病人左心室功能损害。

Objective To evaluate the clinical significance of tissue Doppler imaging （TDI） in assessing the damage of left ventricular function caused by cardiotoxic anthracycline chemotherapy in patients with malignancy. Methods Fifty patients with malignancy were divided into two groups： those treated with anthracycline as group Ⅰ ; others treated with other chemotherapeutics as group Ⅱ. Echocardiography and TDI were performed both before chemotherapy and six months later after the treatment. Results TDI showed that the peak motion velocity of mitral annulus during early diastolic period （Em） decreased （t=3.01, 2.23; P〈0. 01, 0.05） and peak motion velocity during atria contraction period （Am） increased, both were significantly （t=2. 96,2.16, P〈0. 01,0. 05） after chemotherapy. The ratio of Em/Am decreased markedly （t=2. 81,2. 09;P〈0. 01,0. 05） in both groups. The peak motion velocity of mitral annulus during systolic period （Sm） obviously decreased after chemotherapy in group Ⅰ （t= 2.43,P〈0.05）, while no significant changes were noted in group Ⅱ （t=2.00, P〈0.05）. The parameters of TDI were signifi candy different between the two groups （t=2.03- 2.08,P〈0.05）. Parameters of echocardiography showed that left ventricular short-axis systolic functions after chemotherapy were not significantly different as compared with the data acquired before the therapy （t=1.99 -2. 03,P〉0. 05）. Abnormalities of routine diastolic function index of left ventricle appeared only in 13 patients （26%）. Conclusion Compared with echocardiography, TDI can detect the abnormalities of left ventricular function of patients with malignancy earlier.