声学密度定量技术在胸部放疗致心脏损害评价中的应用

Assessment of Heart Damage Induced by Chest Radiotherapy with Acoustic Densitometry

目的探讨常规超声心动图及声学密度定量技术评价胸部放疗致心脏损害的临床应用价值。方法测定并比较120例胸部肿瘤患者放疗前和放疗后6个月的常规超声心动图参数及声学密度定量参数;以29例健康志愿者作为平行对照组,记录其在相同时间间隔内的上述参数变化。结果与放疗前相比,15例患者(12.5%)出现常规超声心动图检查异常;声学密度定量显示部分患者心肌平均背向散射积分(IBS)、IBS%升高,心肌背向散射积分周期变化幅度(CVIB)、CVIB%降低。其中,放疗联合蒽环类化疗组上述参数的变化比单纯放疗组和放疗联合其他化疗剂组更为明显;放疗联合其他化疗剂组的心脏损害较单纯放疗组显著。平行对照组在首次检查6个月后再查未出现上述参数异常。结论常规超声心动图及声学密度定量技术可用于评价放疗所致的心脏结构、功能和血流动力学异常。与常规超声心动图检查相比,声学密度定量技术能更早、更敏感地评价放疗致心脏微观结构改变和功能受损。放疗联合化疗尤其是蒽环类化疗剂可加重心脏损害。

Objective To explore the clinical application of acoustic densitometry （AD） in assessing heart damage induced by chest radiotherapy in patients with thoracic tumors. Methods Altogether 120 patients received chest radiotherapy were examined by echocardiography and acoustic densitometry before radiotherapy and six months later. Additionally, 29 healthy volunteers were enrolled as control group. Results Some abnormal echocardiography characters appeared in 15 patients after chest radiotherapy （12.5%）. AD showed that integrated back-scatter （IBS） and IBS%was signiifcantly higher;while cyclic variation of IBS （CVIB） and CVIB% were signiifcantly lower than those obtained before irradiation. Among patients received combination of radiotherapy and anthracyclines treatment, the changes of parameters acquired from AD differed signiifcantly from those patients treated by simplex irradiation or combination of radiotherapy and other chemotherapeutic drugs. At the same time, those data in patients received combination of radiotherapy and other chemotherapeutic drugs differed signiifcantly from those patients treated by simplex irradiation. As to the control group, all of the parameters changed insigniifcantly six month later. Conclusion Echocardiography and AD can be used in assessing early heart damages induced by chest radiotherapy. Compared with echocardiography, AD was more sensitive in detecting microcosmic changes and abnormalities of heart functions. Combination of radiotherapy and anthracyclines or other chemotherapeutic drugs can aggravate the heart damage.