Tei指数联合血清超敏肌钙蛋白T早期诊断蒽环类化疗药物致心脏毒性的价值

Estimation of the value of echocardiographic Tel index combined with serum high-sensitivity cardiac troponin T assay in early diagnosis of anthracycline-induced cardiotoxicity

目的探讨心脏做功指数（Tei指数）联合血清超敏肌钙蛋白T（hs—cTnT）对弥漫大B细胞淋巴瘤（DLBCL）患者蒽环类化疗药物致心脏毒性的早期诊断价值。方法56例行蒽环类药物化疗的DLBCL患者分别于化疗前、化疗2～4周期（累积剂量100～200mg／m2），化疗6～8周期（累积剂量300-400mg／m2）行左右心脉冲多普勒Tei指数（传统Tei指数）、组织多普勒Tei指数（TDI-Tei指数）及心脏核素检查，部分患者同期行血清hs—cTnT浓度检测。定义化疗过程中核素左心室射血分数（LVEF）下降≥10％或化疗完成后核素LVEF绝对值≤50％为发生心脏毒性事件。结果与化疗前比较，56例DLBCL患者左心传统Tei指数随化疗周期改变差异具有统计学意义[0．36±0．12对0．44±0．13对0．40±0．13，P=0．002]。患者化疗前后血清hs—cTnT水平差异具有统计学意义[（0．006±0．006）μg／L对（0．012±0．007）μg／L对（0．020±0．013）μg／L，P=0．001]。化疗2～4周期血清hs—cTnT增量联合化疗6～8周期左心传统Tei指数增量对蒽环类药物心脏毒性早期预测的敏感性、特异性及ROC曲线下面积分别为75％、85％、0．736和92％、50％、0．675（均P〈0．05）。结论Tei指数联合血清hs—cTnT水平能够及时反映蒽环类药物心脏毒性的早期改变，且检测方法简单易行，在基层医院亦可实施。

Objective To investigate the value of echocardiographic Tei index combined with serum high-sensitivity cardiac troponin T（hs-cTnT） on monitoring cardiac toxicity associated with anthracycline chemotherapy drug in patients with diffuse large B-cell lymphoma（DLBCL）. Methods PW-Tei index, TDI- Tei index of left/right ventricles and radionuelide cardiac measurement were acquired from 56 patients with DLBCL before, after the completion of 2- 4 cycle（100- 200 mg/m2） and 6- 8 cycle（300- 400 mg/m2） of the regimen, part of them received serum hs-cTnT detection at the same time. Cardiac toxicity event was defined as a relative reduction of radionuclide left ventricular ejection fraction（LVEF） of ≥10% during the regime or an absolute radionuelide LVEF≤50% after the complete chemotherapy. Results Compared with baseline, left ventricular PW-Tei index significantly increased after whole cures [（0.36 ± 0.12） vs （0.44 ± 0.13） vs （0.40± 0.13）, P = 0. 002]. After complete regimen, serum hs-eTnT level elevated significantly [（0.006±0.006）μg/Lvs （0.012±0.007）μg/L vs （0.020±0.013）μg/L, P =0.001]. The sensitivity, specificity and area under ROC curve of early diagnosis of anthracycline-induced cardiotoxicity with elevated serum hs-cTnT in 2 - 4 cycle and increased left ventrieular PW-Tei index in 6-8cycle detected together were 75%,85%,0.736 and 92%,50%,0.675,respectively（allP〈0.05）. Conclusions Echocardiographic PW-Tei index combined with serum hs-cTnT is a simple method and can be easily obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy.