蒽环类药物心肌损伤患者常规超声心动图和速度向量成像参数比较

The comparison of conventional echocardiography and velocity vector imaging parameters of anthra-cyclines myocardial damage

目的比较常规超声心动图和速度向量成像(velocity vector imaging,VVI)参数在蒽环类药物心肌损伤患者中的应用效果。方法将2015年5月至2016年2月于上海交通大学附属第六人民医院采用表柔比星治疗的40例乳腺癌患者纳入观察组,所有患者均完成3个疗程的化疗,并将同期于本院进行健康体检的30例志愿者纳入对照组,比较两组研究对象超声心动图和VVI参数的差异。结果观察组患者化疗前及化疗后各时间段常规超声心动图均在正常范围内,与对照组比较均无显著差异(P>0.05)。当表柔比星累积剂量达到225 mg/m2(3个疗程后)时,左心室速度向量图出现明显异常,可出现心肌运动不协调,速度向量长短不一,收缩期和舒张期各节段峰值应变和应变率均明显低于对照组和化疗前(P<0.05),但观察组患者化疗1个疗程后和2个疗程后收缩期和舒张期各节段峰值应变和应变率均未见明显变化(P>0.05)。结论 VVI技术可以及时发现心肌病变,较常规超声心动图更敏感,且有助于早期发现心肌损伤。

Objective To investigate the effect of conventional echocardiography and velocity vector imaging （VVI） parameters in patients with anthracyclines myocardial damage. Method 40 cases of breast cancer treat with epirubicin from May 2015 to February 2016 in the Sixth People＇s Hospital were selected as observation group, and at the same period in the hospital 30 cases of healthy volunteers embedded in control group, echocardiography and VVI results were compared between the two groups. Result Before and after chemotherapy, conventional echocardiography of observation group were within the normal range, there was no significant difference between the two groups （P 〉 0.05）. When the cumulative dose of epirubicin reached 225 mg/m2, left ventricular velocity vectors appear abnormal, appeared myocardial motion coordination, velocity vectors of different lengths, each segmental systolic and diastolic peak strain and strain rate decreased significantly lower than control group and before chemotherapy （P 〈 0.05）, but after 1 cycle of chemotherapy and 2 cycles of chemotherapy, segmental systolic and diastolic peak strain and strain rate of observation group had no significant changes （P 〉 0.05）. Conclusion VVI can detect myocardial lesions in a timely manner, and it is more sensitive to the early detection of myocardial damage than the heart color Doppler ultrasound.