二维斑点追踪成像技术在评价蒽环类药物心脏毒性中的临床价值

Value of two-dimensional speckle tracking imaging technology in the evaluation of cardiac toxicity caused by anthracycline

目的探讨二维斑点追踪成像技术在评价蒽环类药物心脏毒性方面的临床价值。方法 100例使用蒽环类药物化疗的乳腺癌患者,根据化疗后心电图是否正常分为两组:A组52例,化疗后心电图正常;B组48例,化疗后心电图异常;对照组为50例健康志愿者。分别于化疗前后行常规超声心动图及纵向峰值应变参数测定。结果化疗前,三组间纵向峰值应变参数比较差异均无统计学意义;化疗后,A组大部分节段纵向峰值应变下降(P﹤0.05),B组各节段纵向峰值应变显著下降(P﹤0.01),B组患者前间隔、后间隔、左室后壁的纵向峰值应变较A组患者减低(P﹤0.05)。结论心电图检查不是监测蒽环类化疗药心脏毒性敏感指标,但心电图异常对心功能的损害有一定的提示意义;二维斑点追踪技术作为评价心肌应变的新方法,有助于早期发现蒽环类药物致乳腺癌患者的心脏毒性。两种检查方法的合理利用能及早发现心肌功能的亚临床损害,为及时改善化疗方案提供一定帮助。

Objective To investigate the value of two-dimensional speckle tracking imaging technology in the evaluation of cardiac toxicity caused by anthracycline.nethods A total of 100 patients with breast cancer receiving chemotherapy of anthracycline were divided into two groups according to the electrocardiographic examination results, including 52 cases in group A （normal electrocardiogram） and 48 cases in group B （electrocardiographic abnormality）.Fifty healthy people were enrolled as control.The strain rate imaging（ SRI ） and conventional echocardiographie parameters were determined before and after the chemotherapy.Results Before chemotherapy, there were no significant differences in SRI parameters among the three groups.After chemotherapy,the longitudinal peak strains of most segments in group A and all segments in group B were reduced （P 〈 0.05）. Compared with group A , the longitudinal peak strains of anterior, posterior septum and left ventricular posterior wall of patients in group B were lower （P 〈 0.05）. Conclusion Electrocardiography examination is not a sensetive indicator for monitoring cardiac toxicity caused by anthracycline but abnormal electrocardiography is helpful to indicate heart function damage.