实时三维超声心动图评估胃癌患者蒽环类药物治疗后左心功能不全的价值

The value of real-time three-dimensional echocardiography in detecting left ventricular dysfunction in patients with gastric cancer treated with anthracyclines

目的探讨实时三维超声心动图(RT3DE)评估胃癌患者蒽环类药物治疗后早期左心室功能不全的价值。方法2017年2月至2019年12月余杭区第一人民医院36例胃癌患者行蒽环类药物治疗,分别于化疗前、化疗3周期后及化疗6周期后行常规超声心动图、RT3DE及心脏MRI检查,分别测量左心室射血分数(LVEF):2D-LVEF、RT3DE-LVEF、MRI-LVEF,同期测定血清高敏肌钙蛋白T(hs-c Tn T)水平,比较化疗前后的左心功能变化。结果化疗3周期时血清hs-c Tn T水平(4.04±0.87)pg/m L,较化疗前(1.82±0.22)pg/m L升高,差异有统计学意义(P<0.05);化疗6周期时血清hs-c Tn T水平(6.12±0.95)pg/m L较化疗前、化疗3周期时升高,差异均有统计学意义(均P<0.05)。化疗3周期时RT3DE-LVEF、MRI-LVEF[(64.28±5.76)%、(62.34±5.18)%]较化疗前[(68.14±4.89)%、(67.69±4.63)%]下降,化疗6周期时RT3DE-LVEF、MRI-LVEF[(61.01±5.43)%、(59.08±5.70)]较化疗前、化疗3周期时下降,差异均有统计学意义(均P<0.05)。RT3DE-LVEF与MRI-LVEF呈正相关(r=0.92,P<0.05),与血清hs-c Tn T水平呈负相关(r=-0.84,P<0.05)。结论RT3DE检查有利于发现胃癌患者蒽环类药物治疗后的早期左心功能损害。

Objective To explore the value of real-time three-dimensional echocardiography(RT3 DE)in detecting early left ventricular dysfunction in patients treated with anthracyclines for gastric cancer.Methods 36 gastric cancer patients in the First People’s Hospital of Yuhang treated with anthracyclines were enrolled from Feb 2007 to Dec 2019.Routine echocardiography,RT3 DE and cardiac MRI were performed before chemotherapy,after 3-cycle and 6-cycle chemotherapy,respectively.Left ventricular ejection fraction(LVEF),including 2 dimensional-LVEF、RT3 DE-LVEF and MRI-LVEF,was measured.Meanwhile,serum high-sensitive troponin T(hs-c Tn T)was measured.The changes of left ventricular function before and after chemotherapy were compared.Results Serum hs-c Tn T after 3-cycle chemotherapy was significantly higher than that before chemotherapy(P<0.05).Serum hs-c Tn T after 6-cycle chemotherapy was significantly higher than those before chemotherapy and after 3-cycle chemotherapy(all P<0.05).RT3 DE-LVEF and MRI-LVEF after 3-cycle chemotherapy were significantly lower than those before chemotherapy(P<0.05).RT3 DE-LVEF and MRI-LVEF after 6-cycle chemotherapy were significantly lower than those before chemotherapy and after 3-cycle chemotherapy(all P<0.05).There was a positive correlation between RT3 DE-LVEF and MRI-LVEF(r=0.92,P<0.05),and a negative correlation between RT3 DE-LVEF and serum hs-c Tn T(r=-0.84,P<0.05).Conclusion RT3 DE examination is favorable to detect early left ventricular dysfunction in gastric cancer patient treated with anthracyclines.