斑点追踪成像技术评价蒽环类药物及曲妥珠单抗治疗乳腺癌患者左室心肌应变的研究

Measurements of longitudinal strain of left ventricle using speckle tracking imaging in breast cancer patients treated by anthracyclines and trastuzumab

目的：应用二维斑点追踪成像技术评估蒽环类药物及曲妥珠单抗治疗早期乳腺癌患者的心脏毒性。方法选取曲妥珠单抗联合蒽环类、紫杉类药物治疗的人类表皮生长因子受体2（HER2）阳性乳腺癌患者58例，在药物治疗前（A组）、蒽环类药物使用后（B组）、曲妥珠单抗治疗3个月（C组）、曲妥珠单抗治疗12个月（D组）分别行二维超声心动图检查，记录心尖位左四腔观、二腔观及长轴观图像，常规记录左室舒张末内径（LVEDD）、室间隔厚度（IVST）、左室后壁厚度（PWTD）、左室舒张末容积（LVEDV）、左室收缩末容积（LVESV），使用Simpson法进行左室射血分数（LVEF）测量。应用QLAB 8.0软件分析获得左室整体纵向应变值（GLS）及应变率（LSR）。结果 A～D组LVEDD分别为（47.95±4.12）、（48.45±4.02）、（48.91±3.83）、（49.98±3.72） mm，LVEDV分别为（108.70±21.26）、（111.90±20.91）、（113.50±20.25）、（119.20±20.02） ml。 B组与A组相比，LVEDD、PWTD [（9.14±0.76） mm比（9.00±0.82） mm]、LVEDV、LVESV[（54.60±14.58） ml比（50.97±14.35） ml]增加（P＜0.05）。 C组与B组相比，LVEDD、LVEDV增加（P＜0.05）。 D组与C组相比，LVEDD、LVEDV、LVESV[（59.18±13.88）ml比（55.23±13.81）ml]进一步增加（P＜0.05），LVEF差异有统计学意义[（59.48±2.62）%比（62.00±1.40）%，P＜0.001]。四组间GLS[A～D组：（-21.16±2.33）%、（-19.76±1.98）%、（-19.22±1.89）%、（-18.74±1.79）%]、LSR[A～D组：（-1.27±0.11）／s、（-1.22±0.09）／s、（-1.17±0.07）／s、（-1.14±0.06）／s]比较，差异均有统计学意义（均P＜0.001）。结论乳腺癌患者蒽环类药物及曲妥珠单抗治疗时出现左室纵向收缩功能减低，二维斑点追踪可作为其早期评价的无创性检查方法。

Objective To examine cardiotoxicity of anthracyclines and trastuzumab in patients with breast cancer by two dimensional speckle tracking imaging. Methods Fifty-eight human epidermal growth factor receptors-2 （HER2） positive patients with breast cancer treated by anthracyclines and trastuzumab were monitored by echocardiography before treatment （Group A）, after completion of anthracyclines （Group B）, and at follow-up of 3 months （Group C） and 12months （Group D） after using trastuzumab. LVEDD, IVSTD, PWTD, LVEDV, LVESV were measured in the apical four- and two-chamber views. Left ventricular ejection fraction （LVEF） was measured using a modified Simpson＇s biplane method. Global longitudinal strain （GLS） and longitudinal strain rate （LSR） were calculated via Qlab8.0 analysis software off-line. Results LVEDDs in A-D groups were （47.95 ±4.12）, （48.45 ±4.02）, （48.91 ±3.83） and （49.98 ±3.72） mm, respectively, and LVEDVs were （108.70 ±21.26）, （111.90 ±20.91）, （113.50 ±20.25） and （119.20 ±20.02） ml, respectively. LVEDD, PWTD [（9.14 ±0.76） mm vs. （9.00 ±0.82）mm], LVEDV, LVESV [（54.60 ±14.58） ml vs. （50.97 ±14.35） ml] were increased in group B compared with those in A group （all P〈0.05）. LVEDD and LVEDV were increased in group C（P〈0.05） compared with those in group B. CLVEDD, LVEDV, LVESV [（59.18±13.88） ml vs. （55.23± 13.81） ml] were increased in group D compared with group （P〈0.05）. Differences of LVEF between group C and group D were statistically significant[（59.48±2.62） % vs. （62.00±1.40） %, P〈0.001]. Differences of GLS [（-21.16±2.33）%, （-19.76±1.98） %, （-19.22±1.89） % and （-18.74±1.79） %, respectively, P〈0.001] and LSR [（-1.27±0.11）, （-1.22±0.09）, （-1.17±0.07） and （-1.14±0.06） /s, respectively, P〈0.001] among four groups had all statistically significant. Conclusions Longitudinal left ventricle systolic function are impaired in patients with breast cancer treated by anthracyclines and trastuzumab. GLS and LSR of myocardium traced by two dimensional speckle tracking imaging would be useful for early evaluation of the severity.