三维斑点追踪技术评价肺癌患者培美曲塞联合顺铂化疗方案的心肌毒性

Evaluation of myocardial damage in lung cancer patients receiving chemotherapy with pemetrexed combined with cisplatin by three-dimensional spot tracking imaging technology

目的探讨应用三维斑点追踪技术评价非小细胞肺癌(NSCLC)患者培美曲塞联合顺铂化疗方案心肌毒性的价值。方法追踪观察38例NSCLC患者化疗前、化疗3周期和化疗6周期的常规超声心动图、心脏组织多普勒及三维斑点追踪表现。比较3组间左心室整体面积应变(GAS)、整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS)及常规超声心动图参数和组织多普勒参数的差异,并应用受试者工作特性(ROC)曲线评价三维应变参数对诊断心肌毒性的应用价值。结果化疗6周期GAS、GLS、GCS明显低于化疗前(P<0.05),化疗6周期GAS、GLS明显低于化疗3周期(P<0.05),化疗3周期GAS、GLS明显低于化疗前(P<0.05)。化疗6周期的组织多普勒舒张早期峰值(Em)及舒张早期、晚期峰值比(Em/Am)与化疗前、化疗3周期比较差异有统计学意义(P<0.05),化疗前与化疗3周期的Em/Am比较差异有统计学意义(P<0.05)。ROC曲线显示,GAS、Em/Am的ROC曲线下面积分别为0.929及0.813,差异有统计学意义(P<0.05),GAS以-30.5%为截断值时,判断化疗药物对左室功能损害的特异性为88.2%,敏感性为81.6%。结论 3D-STI应变参数能早期敏感地反映培美曲塞联合顺铂化疗方案的心肌毒性,GAS诊断化疗药物对心肌毒性的特异性、敏感性较高,可以为临床检测化疗药的心肌毒性提供早期、敏感、准确的方法。

Objective To explore the value of three-dimensional speck tracking imaging （3D-STI） in evaluating myocardial damage of chemotherapy with pemetrexed combination use with cisplatin to non-small cell lung cancer patients. Methods 38 patients with non-small cell lung cancer were enrolled in this study. Each patient underwent electrocardiogram, conventional echocardiography, TDI and 3D-STI before chemotherapy, at 3 chemotherapeutic cycles and at 6 chemotherapeutic cycles. Left ventricular global area strain （GAS）, global longitudinal strain （GLS）, global circumferential strain （GCS）, global radial strain （GRS）, conventional echocardiography and TDI parameters were recorded and compared. The receiver operating characteristics（ROC） curve was constructed to de- termine optimal cut-off value for the prediction of future cardiotoxicity. Results GAS, GLS and GCS were significantly lower at 6 chemotherapeutic cycles than that before chemotherapy （ P 〈 0. 05 ） , while GAS and GLS were lower at 6 chemotherapeutic cycles than that at 3 chemotherapeutic cycles significantly （P 〈 0. 05 ）. The comparison of GAS and GLS before chemotherapy and at 3 chemotherapeutic cycles showed significant difference （P 〈 0. 05 ）. Em and Em/Am were lower at 6 chemotherapeutic cycles than that before chemotherapy and at 3 chemo-therapeutic cycles significantly（ P 〈 0. 05 ）. Em/Am was significantly lower before chemotherapy than that at 6 chemotherapeutic cycles （P 〈 0. 05 ）. The area under ROC curve of GAS was 0. 929, and its optimal cut-off value was -30.5% , with a specificity of 88.2% and sensitivity of 81.6%. Conclusion Strain parameters acquired by 3D- STI can early detect myocardial damage in lung cancer patients receiving chemotherapy with pemetrexed combination use with cisplatin, while GAS has a high specificity and sensitivity in detecting of left ventricular myocardial dysfunction, which may provide an early, sensitive and accurate method for detecting cadiotoxicity.