超声压力-应变环技术评价乳腺癌化疗后心肌做功能力的改变

Ultrasonic Pressure-Strain Loops Technique in Evaluating the Changes of Myocardial Function After Breast Cancer Chemotherapy

目的应用压力-应变环技术(PSL)评价乳腺癌患者使用蒽环类药物后的左心室收缩功能改变,探讨其在评价化疗早期心肌毒性中的应用价值。资料与方法选取经病理确诊的乳腺癌患者35例,左心室射血分数(LVEF)均>55%,所有患者均接受蒽环类药物化疗。分别于化疗前及化疗3个周期后行二维超声心动图检查左心室功能参数,包括左心室舒张末期内径(LVEDd)、左心室舒张期容积(LVEDV)、左心室收缩末期内径(LVEDs)、左心室收缩期容积(LVESV)、LVEF和左心室短轴缩短率(FS),作为化疗前及化疗后组;选取同期健康志愿者20例作为对照组。分析左心室应变及做功参数指标的相关性。结果与对照组比较,化疗前LVEDd、LVEDV、LVEDs、LVESV、LVEF、FS差异均无统计学意义(P>0.05),左心室纵向收缩期峰值应变(GLS)、整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE)差异无统计学意义(P>0.05);与乳腺癌化疗前及对照组比较,化疗后LVEDd、LVEDV、LVEDs、LVESV、LVEF、FS差异均无统计学意义(P>0.05),GLS、GWI、GCW及GWE较低,GWW较高,差异有统计学意义(P均<0.05)。GLS与GWI、GCW呈正相关(R^2=0.729、0.777,P<0.01),GLS与GWW、GWE无明显相关性(P>0.01)。结论PSL测得GWI、GCW、GWW、GWE各参数结合GLS分析能较早地发现乳腺癌患者使用蒽环类化疗后的心功能障碍,为早期临床干预提供参考依据。

Purpose To evaluate the left ventricular systolic function changes in breast cancer patients after using anthracyclines by using pressure-strain loops(PSL),and to explore its application value in evaluating early myocardial toxicity of chemotherapy.Materials and Methods Thirty-five patients with pathologically confirmed breast cancer,with left ventricular ejection fraction(LVEF)>55%were selected.All patients received anthracycline chemotherapy.Two-dimensional echocardiography was performed before and after 3 cycles of chemotherapy to obtain left ventricular function parameters,including left ventricular end-diastolic diameter(LVEDd),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic diameter(LVEDs),left ventricular end-systolic volume(LVESV),LVEF and left ventricular fractional shortening(FS).Twenty healthy volunteers of the same period were selected as the control group.The correlation between left ventricular strain and work parameters was analyzed.Results Compared with the control group,there was no significant difference in LVEDd,LVEDV,LVEDs,LVESV,LVEF and FS before chemotherapy(P>0.05);the left ventricular longitudinal systolic peak strain(GLS),global work index(GWI),overall effective work(GCW),global invalid work(GWW)and overall work efficiency(GWE)were not statistically different(P>0.05);compared with those before breast cancer chemotherapy and the control group,there was no significant difference in LVEDd,LVEDV,LVEDs,LVESV,LVEF and FS after chemotherapy(P>0.05);GLS,GWI,GCW and GWE were low,and GWW was high,with statistical difference(P<0.05).GLS was positively correlated with GWI and GCW(R^2=0.729 and 0.777,P<0.01),GLS showed no significant correlation with GWW and GWE(P>0.01).Conclusion GWI,GCW,GWW and GWE measured by PSL combined with GLS analysis can early detect the heart dysfunction of breast cancer patients after anthracycline chemotherapy,providing a reference for clinical intervention.