肌钙蛋白测定和超声2D-STI观察紫杉醇联合顺铂方案对心脏的亚临床损害

Observation of heart functions in patients with cancer receiving combined chemotherapy of paclitaxel plus cisplatin using cardiac troponin level and speckle tracking echocardiography

目的应用血清肌钙蛋白测定和超声二维斑点追踪成像(2D-STI)动态观察紫杉醇联合顺铂方案的心脏毒性。方法选取病理证实的43例恶性肿瘤患者进行追踪观察。每例分为化疗前、首次化疗后、全疗程一半、全疗程结束4个阶段。进行血清肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)检测及心电图检查,同时应用2D-STI检测左室收缩期整体纵向应变(GSL)及应变率(GSRs)、舒张早期及舒张晚期整体纵向应变率(GSRe、GSRa)。结果初次化疗后、全疗程一半、全疗程结束时cTnT、cTnI依次逐渐升高,与化疗前比较,差异均有统计学意义(P<0.01)。化疗中期GSRe、GSRa减低差异有统计学意义(P<0.01),GSL、GSRs虽有所减低但差异无统计学意义(P>0.05);化疗结束时GSL、GSRs、GSRe、GSRa均减低,差异有统计学意义(P<0.01)。结论紫杉醇联合顺铂方案具有一定的心脏毒性,血清肌钙蛋白水平的测定和2D-STI结合在观察化疗药物的心脏毒性中具有很高的价值。

Objective To observe heart functions of the patient with cancer receiving combined chemotherapy of paclitaxel plus cisplatin through troponin test and speckle tracking echocardiography. Methods 43 patients who had been scheduled to receive combined chemotherapy of paclitaxel plus cisplatin were recruited in the study. Ser- um cTnT and cTnI levels were measured before chemotherapy, after the first cycle of chemotherapy, middle cycle of chemotherapy and after＂ the last cycle of chemotherapy. In all patients, the lobal longitudinal systolic strain（GSL） and strain rate （GSRs） of the LV as well as peak early-diastolic strain rate （GSRe） and peak late-diastolic strain rate （GSRa） were measured by two-dimensional speckle tracking echocardiography at every stage. Results The patients＇ serum cTnT and cTnI level after chemotherapy were increased gradually（P 〈0. 01 ）. After the last stage of chemotherapy the GSL and GSRs decreased significantly, having made significance in statistics （P 〈 0. 01 ）. Compared with those before chemotherapy, the patients＇ GSRe and GSRa in the early stage of chemotherapy had no significant difference （P 〉 0.05 ）, but compared to those of the middle and last stage of chemotherapy, significant difference （P 〈 0. 01 ） existed. Conclusion Paclitaxel plus cisplatin induce certain subclinical myocardial injury to patient＇ s heart. Cardiac troponin level and speckle tracking echocardiography have important value in the obser- vation of heart functions of the patients with cancer receiving chemotherapy.