应用二维斑点追踪成像技术监测急性淋巴细胞白血病柔红霉素化疗患儿左室扭转功能探讨

Assessment of left ventricular torsion in children with acute leukemia receiving chemotherapy of daunorubicin using two-dimensional speckle tracking imaging

目的探讨应用二维斑点追踪成像技术监测柔红霉素化疗对急性淋巴细胞白血病(急淋)患儿左心室短轴心肌扭转功能的影响,分析心脏功能损伤与柔红霉素不同累积剂量的关系。方法研究对象为2007年1月至2009年12月深圳市儿童医院诊断的急淋患儿60例,均接受柔红霉素化疗,按治疗程序分为A组(化疗前)、B组(柔红霉素化疗累积剂量达120mg/m2)和C组(柔红霉素化疗累积剂量达240mg/m2)。对照组为同期体检正常儿童60名。检测每组常规超声心动图指标左室射血分数(EF)、二尖瓣口舒张期血流比值(E/A),并应用超声二维斑点追踪成像技术(two-dimensional speckle tracking imaging,2DSI)检测对照组及A、B、C组的左室短轴基底段和心尖段的心肌节段收缩期峰值旋转度,计算左室心肌收缩期峰值扭转角度。结果心率、EF、二尖瓣口舒张期E/A比值在对照组、A、B、C各组间比较,差别无统计学意义(P>0.05)。A、B组与对照组比较,基底段和心尖段的峰值旋转角度差异无统计学意义(P>0.05);C组与对照组比较心尖段峰值旋转角度,差异无统计学意义(P>0.05);C组与对照组、A组、B组比较,基底段峰值旋转角度差异有统计学意义(F=5.23,P<0.05)。A、B组与对照组比较,左室扭转角度差异无统计学意义(P>0.05),但C组小于对照组、A组、B组,差异有统计学意义(F=4.51,P<0.05)。结论急淋患儿柔红霉素化疗累积剂量达120mg/m2时未发现心脏扭转功能损伤,当达到240mg/m2时,心脏扭转功能出现显著损伤,2DSI可无创性定量监测患儿心脏功能的变化,对临床评价柔红霉素的心脏毒性、预防化疗后遗症的发生有重要意义。

Objective To assess the left ventricular torsion in children with acute leukemia after induced therapy by daunorubicin （DNR）. Methods A total of 60 healthy volunteers served as controls;60 children with acute leukemia before and after induced therapy by DNR were enrolled. All the child patients were divided into three groups according to course of therapy by DNR. Group A： patients before induced therapy by DNR; Group B ： patients undergoing induced DNR with accumulated dose of 120 mg/m2; Group C： patients induced DNR with accumulated dose of 240 mg/m2. The left ventricular short-axis images at the levels of mitral annulus and apex were acquired. Using 2-dimensional strain software, the peak systolic rotations were measured in the left ventricular short-axis images and the peak systolic torsions were calculated. Results There was no significant difference between control group and group, A, B and C in EF and E/A. In healthy volunteers, the left ventricular performed a systolic torsion, with a counterclockwise rotation at the apex and a clockwise rotation at the mitral annulus. In the children with acute leukemia receiving induced therapy by DNR with accumulated dose of 240 mg/m2, the peak systolic rotations of the level of mitral annulus and the peak systolic torsion were decreased. Conclusion The early changes of left ventricular regional myocardial systolic function in children with acute leukemia after induced therapy by DNR with accumulated dose of 240mg/m2 can be measured by two-dimensional speck-le tracking imaging.