斑点追踪技术评价成人急性淋巴细胞白血病患者柔红霉素化疗后心肌损害的价值

Value of speckle tracking echocardiography in evaluation of myocardial damage after daunorubicin chemotherapy in patients with acute lymphoblastic leukemia

目的探讨二维斑点追踪技术监测柔红霉素对成人急性淋巴细胞白血病患者的心脏毒性作用,并分析柔红霉素不同累积剂量与心肌损害的关系。方法选择46例临床诊断的急性淋巴细胞白血病患者,均接受柔红霉素化疗,按累积剂量分为三组,A组(化疗前)、B组(柔红霉素累积剂量达240mg/m2)、C组(柔红霉素累积剂量达360mg/m2)。应用二维斑点追踪技术测量各组左室各节段收缩期纵向峰值应变和常规超声心动图参数,并进行对比分析。结果 1)各组间比较,左室后壁厚度、室间隔厚度、左室舒张末期容积、左室收缩末期容积、LVEF、E/A值差异无统计学意义;2)B组与A组比较,除下壁基底段和下壁中间段外,左室各节段纵向收缩期峰值应变差异有统计学意义。其中后壁的心尖段和侧壁的心尖段的纵向收缩期峰值应变下降更明显;3)C组与A组比较,左室各节段纵向收缩期峰值应变明显下降,差异均有统计学意义;4)B组与C组比较,左室前壁中间段、后壁心尖段、侧壁心尖段、下壁中间段和心尖段、前间隔及后间隔纵向收缩期峰值应变差异有统计学意义,其中C组的左室下壁心尖段和后间隔心尖段纵向收缩期峰值应变下降最明显。结论二维斑点追踪技术可定量监测急性淋巴细胞白血病患者化疗后的左室心肌损害,柔红霉素累积剂量越大,心肌损害越严重,为临床早期评价及干预治疗提供重要依据。

Objective To investigate the effect of daunorubicin （DNR） on myocardial damage by two-dimensional speckle tracking echocardiography （2D-STE） in adult patients with acute lymphoblastic leukemia and to analyze the relationship between cumulative dose of daunorubicin and myocardial damage.Methods 46 patients with acute lymphoblastic leukemia, who were all treated with daunorubicin, were selected in this work. Those patients were divided into three groups, i.e., group A （before chemotherapy）, group B （daunorubicin cumulative dose of 240 mg/m 2）, and group C （daunorubicin cumulative dose of 360 mg/m 2）, according to the cumulative dose. The peak systolic longitudinal strain and conventional echocardiographic parameters were measured by two-dimensional speckle tracking and those obtained data were compared subsequently.Results 1） In comparison to the data between each group, there were no significant differences in terms of left ventricular posterior wall thickness at diastole, inter-ventricular septum thickness at diastole, left ventricular diastolic diameter, left ventricular systolic diameter, and left ventricular ejection fraction and E/A; 2） Compared the data in group B with group A, except the inferior basal segment and middle segment of inferior wall, there were statistically significant differences in left ventricular longitudinal peak strain of each segment. The longitudinal peak strain of the apical segment of the posterior wall and the apical segment of the lateral wall decreased more obviously; 3） Compared the data in group C with group A, the longitudinal peak was significantly decreased, the differences were statistically significant; 4） Compared the data in group B with group C, there was statistical significance in the middle section of anterior wall, the apical segment of the posterior wal, the apical segment of lateral wall, middle segment and apical segment of inferior wall, and the postseptal and anteriorseptal. The longitudinal systolic peak strain in the apical segment of inferior wall and the apical segment of the postseptal decreased most obviously in C group.Conclusion Two dimensional speckle tracking can be used to monitor the left ventricular myocardial damage in patients with acute lymphoblastic leukemia after chemotherapy by daunorubicin. The greater the cumulative dose of daunorubicin is, the much severe myocardial damage occurs. This provides an important basis for early clinical evaluation and intervention treatment of the disorder.