收缩达峰时间离散度评价食管癌患者放疗前后左心室收缩同步性的应用价值

Value of peak strain dispersion for assessment of left ventricular contraction synchronization in patients with esophageal carcinoma before and after radiotherapy

目的探讨收缩达峰时间离散度(PSD)评价食管癌患者放疗前后左心室收缩同步性的应用价值。方法选取2017年10月至2018年7月在苏北人民医院首次接受胸部放射治疗的食管癌患者60例作为放疗组。同期选取年龄、性别相匹配的健康志愿者25例作为对照组。分别于放疗前、放疗中期(放疗14次后)、放疗结束及放疗结束后1个月采用超声心动图机检查相关参数指标并比较。采用SPSS 25.0软件进行统计分析。变量间相关性采用Spearman相关性分析。结果与放疗前相比,放疗组患者放疗中期、放疗结束及放疗结束后1个月的常规超声心动图参数差异无统计学意义(P>0.05)。与放疗前相比,放疗组患者放疗中期、放疗结束及放疗结束后1个月的基底段纵向峰值应变达峰时间(TTPLS)[(361.0±29.0)、(376.6±35.1)、(382.7±33.8)和(370.6±36.9)ms]、以及基底段[(92.86±7.39)、(105.67±25.18)、(124.57±31.61)和(110.98±29.93)ms]和中间段[(66.57±23.64)、(87.56±20.13)、(101.57±17.48)和(84.32±23.81)ms]的纵向应变达峰时间最大差值(Tls-dif)均显著延长(P<0.05),与放疗结束时相比,放疗结束后1个月的上述参数有缩短趋势(P<0.05)。与放疗前相比,放疗组患者放疗中期、放疗结束及放疗结束后1个月的PSD均显著增加[(33.20±7.65)、(36.83±8.20)、(40.91±8.36)和(38.53±9.89)ms],而整体纵向峰值应变(GLPS)均显著降低(P<0.05)。与放疗结束时相比,放疗结束后1个月的PSD与GLPS均有向放疗前恢复的趋势(P<0.05)。Spearman相关性分析结果显示,GLPS绝对值与PSD呈显著负相关(r=-0.61,P<0.01)。结论应用PSD能够评价食管癌患者放疗前后左心室收缩同步性,为临床监测放疗患者心功能,及时调整放疗方案提供帮助。

Objective To explore the application value of peak strain dispersion(PSD)for assessment of left ventricular(LV)synchronization in patients with esophageal carcinoma before and after radiotherapy.Methods A total of 60 patients with esophageal carcinoma who received chest radiotherapy for the first time in the Northern Jiangsu People′s Hospital from October 2017 to July 2018 were enrolled in this study.Another 25 age-and sex-matched health volunteers at the same period served as control.Routine echocardiography examinations were performed before,in the middle of(after 14 times of radiotherapy),after and in 1 month after radiotherapy,and the obtained parameters were compared between the two groups.SPSS statistics 25.0 was used to analyze the data.Spearman correlation analysis was employed for correlation analysis.Results There were no significant differences in the echocardiographic parameters before and in the middle,end and in 1 month after radiation(P>0.05).In the above time points,the time to peak longitudinal strain(TTPLS)in basal segment was(361.0±29.0),(376.6±35.1),(382.7±33.8)and(370.6±36.9)ms,respectively,maximum difference of TTPLS(Tls-dif)in basal segment was(92.86±7.39),(105.67±25.18),(124.57±31.61)and(110.98±29.93)ms,respectively,and it in middle segments was(66.57±23.64),(87.56±20.13),(101.57±17.48)and(84.32±23.81)ms.The differences were gradually extended from the middle to the 1 month after radiotherapy(P<0.05).Compared with the end of radiotherapy,the above parameters showed a shortening trend in 1 month after radiotherapy(P<0.05).Compared with the values before radiation,PSD was increased gradually from the middle to the 1 month after radiotherapy[(33.20±7.65)vs(36.83±8.20)vs(40.91±8.36)vs(38.53±9.89)ms],while the absolute value of global longitudinal peak strain(GLPS)was decreased gradually(P<0.05).The PSD and GLPS values gradually recovered to the pre-radiotherapy levels in 1 months after radiation when compared with those at the end of radiotherapy(P<0.05).Spearman correlation analysis indicated that the absolute value of GLPS was negatively correlated with PSD(r=-0.61,P<0.01).Conclusion PSD can be used to evaluate the left ventricular contraction synchronization in esophageal carcinoma patients before and after radiotherapy,and is helpful for monitoring their cardiac function and timely adjusting radiotherapy regimen in clinical practice.