心肌综合指数评价结直肠癌化疗患者左心室功能的变化

Myocardial composite index to evaluate the changes of left ventricular function in patients with colorectal cancer undergoing chemotherapy

目的利用斑点追踪技术评估结直肠癌患者使用联合药物mFOLFOX6(奥沙利柏+5氟尿嘧啶+亚叶酸钙)化疗前后的左心室心肌功能的变化。方法在本院收集30例病理确诊为结直肠癌的患者,且各位患者均采用mFOLFOX6(奥沙利铂+5⁃氟尿嘧啶+亚叶酸钙)化疗方案,以自身对照做研究,分别在化疗前(T0)、化疗1周期后(T1)、化疗6周期后(T6)、化疗12周期后(T12)的48 h内收集血清肌钙蛋白T(cTnT)数值,随后行常规心脏超声检查,获取参数LVEF、LVFS、LVEDd、IVSd、LVPWd,然后采集左心室的动态图像,进行脱机分析,获取左心室GLS、GAS、GCS、GRS、LVtw并计算得出MCI(MCI=GLS×LVtw),并比较化疗前后这些数值的变化。绘制各参数的ROC曲线,并分析对比MCI、LVEF、GLS与cTnT之间的相关性。结果与化疗前状态相比:化疗末期患者的LVEF、LVFS数值略有下降,差异有统计学意义(P<0.05);患者左心室MCI、LVtw、GLS、GAS、GCS、GRS的绝对值随化疗药物累计剂量的增加而降低,差异有统计学意义(P<0.05),其中GAS、GLS、MCI、LVtw的绝对值在化疗第一周期发生了降低(P<0.05)。MCI的ROC曲线下面积为0.903;GLS的ROC曲线下面积为0.838。MCI与cTnT之间的相关性(r=-0.7228,P<0.001)较GLS与cTnT之间的相关性(r=-0.6008,P<0.001)更强。结论斑点追踪技术有助于早期发现mFOLFOX6致结直肠癌患者左心室心肌功能的变化,各参数中MCI是较为敏感的观测指标。

Objective To investigate the effects of the 3D speckle tracking technique(3D⁃STE)in evalu⁃ating the changes of left ventricular myocardial function in patients with colorectal cancer before and after chemo⁃therapy with mFOLFOX6(oxaliplatin+5⁃fluorouracil+calcium folinate).Method Thirty patients diagnosed with colorectal cancer treated with mFOLFOX6 in our hospital were collected.We used 3D⁃STE to obtain left ventricular parameter:global longitudinal strain(GLS),global area strain(GAS),global circumferential strain(GCS),global radial strain(GRS),left ventricular twist(LVtw)and calculated myocardial composite index(MCI,MCI=GLS×LVtw).We also compare the changes in the above values before and after chemotherapy.We draw the receiver operating curve(ROC)of each parameter and analyze and compare the correlation among MCI,LVEF,GLS and cTnT.Result Compared with the pre⁃chemotherapy state:The absolute values of MCI,LVtw,GLS,GAS,GCS,and GRS of patients decreased with the increase of the cumulative dose of chemotherapeutic drugs.The absolute values of GAS,GLS,MCI and LVtw decreased during the first cycle of chemotherapy(P<0.05).The area under the ROC curve of MCI is 0.903 and the area under the ROC curve of GLS is 0.838.The correlation between MCI and cTnT(r=-0.7228,P<0.001)is stronger than the correlation between GLS and cTnT(r=-0.6008,P<0.001).Conclusion 3D⁃STE is helpful for early detection of changes in left ventricular myocardial function in patients with colorectal cancer caused by mFOLFOX6.MCI is a relatively sensitive observation index among various parameters.