Q-T间期离散度和二维斑点追踪显像诊断乳腺癌患者心肌损伤的临床研究

Clinical Study on Q-T Interval Dispersion and Two Dimensional Speckle Tracking Imaging in the Diagnosis of Myocardial Injury in Patients with Breast Cancer

目的:研究心电图Q-T间期离散度和多普勒二维斑点追踪显像技术,对蒽环类药物化疗的乳腺癌患者进行心脏评估,探讨早期发现心脏功能亚临床损害的可行性及必要性。方法:选择初诊的乳腺癌患者60例,于化疗前、化疗每周期后24~48 h常规进行十二导联心电图描记,测量Q-T间期,测算出Q-T间期离散度值(Q-Tcd)。于化疗前、化疗每周期后24~48 h行心脏常规超声及斑点追踪显像技术检查,测量左室射血分数(LVEF)、左室Tei指数、二尖瓣口舒张早期流速峰值E峰、二尖瓣口舒张晚期流速峰值A峰。组织多普勒测量二尖瓣环室间隔侧舒张期运动速度,E峰、A峰,计算E/A值、E/e值。计算左室收缩期心尖四腔心切面整体纵向峰值应变(GLPS-a4c)、二腔心切面整体纵向峰值应变(GLPS-a2c)、三腔心切面整体纵向峰值应变(GLPS-a3c)、左室平均整体纵向峰值应变(GLPS-avg)。观察蒽环类药物用药前后及各个周期心电图Q-Tcd值和心脏常规超声及斑点追踪显像参数的变化。结果:研究发现不同次数用药后Q-Tcd差异有统计学意义(P<0.05)。随着用药次数增加Q-Tcd延长,差异有统计学意义(P<0.05)。Q-Tcd两两比较,各组间差异均有统计学意义(P<0.05)。患者化疗前后常规超声心动图参数比较,差异无统计学意义(P>0.05)。GLPS-a4c、GLPS-a3c、GLPS-a2c、GLPS-avg各参数随着用药次数的增加,各组差异均有统计学意义(P<0.05)。结论:Q-T间期离散度和二维斑点追踪技术,有助于蒽环类药物致乳腺癌患者心脏毒性的早期发现,为及时改善化疗方案提供依据。

Objective:To discuss the feasiblity and necessity of early detection of subclinical cardiac dysfunction through performing cardiac evaluaton of the patients suffering breast cancer undergoing anthracyclines chemotherapy with Q-T interval dispersion and two dimensional speckle tracking imaging.Methods:Sixty breast cancer patients were chosen to record 12 lead ECG routinely before chemotherapy,24 to 48 hours after each cycle of chemotherapy,detect Q-T interval,calculate dispersion value of Q-T interval(Q-Tcd).To perform conventional echocardiography and two dimensional speckle tracking imaging before chemotherapy,24 to 48 hours after each cycle of chemotherapy,and measure LVEF,Tei index,peak E of early diastolic velocity of mitral valve orifice and peak A of late diastolic velocity of mitral valve orifice.To detect peak E and A of diastolic velocity of mitral annulus interventricular septum using tissue Doppler imaging,to calculate E/A value,E/e value.To calculate GLPS-a4c,GLPS-a2c,GLPS-a3c and GLPS-avg.To observe the changes of Q-Tcd value of ECG at different cycles,conven-tional echocardiography and two dimensional speckle tracking imaging before and after administration of anthracyclines.Results:The study showed that the difference showed statistical meaning in Q-Tcd after different times of administration(P<0.05).As the administration times increased,Q-Tcd prolonged,and it showed statistical meaning(P<0.05).The difference showed statistical meaning in Q-Tcd between both(P<0.05).The difference showed no statistical meaning in the parameters of conventional echocardiography before and after chemotherapy.GLPS-a4c,GLPS-a3c,GLPS-a2c and GLPS-avg increased as the administration times increased,the difference had statistical meaning(P<0.05).Conclusion:Q-Tcd and two dimensional speckle tracking imaging could help early detection of cardiotoxicity induced by anthracyclines,and it could provide the reference for improving chemotherapy regimen timely.