Tei指数联合NT-proBNP对胃癌合并冠心病患者术后化疗药物心脏毒性的评估价值

Value of Tei index combined with NT-proBNP in prediction of cardiotoxicity of postoperative chemotherapy in patients with gastric cancer complicated by coronary heart disease

目的分析心肌做功指数(Tei指数)联合N端B型利钠肽前体(NT-proBNP)对胃癌合并冠心病患者术后化疗药物心脏毒性的评估价值。方法抽取2016年10月至2020年9月郑州大学第一附属医院收治的胃癌合并冠心病术后接受化疗发生化疗药物心脏毒性的患者51例作为发生组,并以1∶1配比抽取同期冠心病合并胃癌术后接受化疗未发生化疗药物心脏毒性的患者51例作为未发生组。检测两组左室射血分数(LVEF)、左心房内径(LAD)、右心房内径(RAD)、Tei指数、NT-proBNP水平。分析Tei指数、NT-proBNP与化疗药物心脏毒性的相关性。结果发生组LVEF低于未发生组,LAD、RAD高于未发生组(P<0.05)。两组第1周期化疗前Tei指数、NT-proBNP水平比较差异均未见统计学意义(P均>0.05)。第1、2、3、4周期化疗后,发生组Tei指数低于未发生组,NT-proBNP水平高于未发生组(P<0.05)。Pearson分析结果显示,Tei指数和LVEF(r=0.612)呈正相关,和LAD(r=-0.643)、RAD(r=-0.695)呈负相关(P均<0.05);NT-proBNP和LVEF(r=-0.619)呈负相关,和LAD(r=0.632)、RAD(r=0.684)呈正相关(P均<0.05)。结论胃癌合并冠心病术后发生化疗药物心脏毒性的患者心功能较差,且Tei指数和NT-proBNP水平存在显著异常,并和化疗周期进展密切相关,临床可依据Tei指数和NT-proBNP水平对化疗药物心脏毒性进行有效评估。

Objective To analyze the value of Tei index combined with N-terminal pro-B-type natriuretic peptide(NT-proBNP)in predicting the cardiotoxicity of postoperative chemotherapy in patients with gastric cancer complicated by coronary heart disease.Methods Fifty-one patients with gastric cancer complicated by coronary heart disease who received chemotherapy after surgery and experienced cardiotoxicity of chemotherapy drugs in the First Affiliated Hospital of Zhengzhou University from October 2016 to September 2020 were selected as the occurrence group.Meanwhile,51 patients with coronary heart disease complicated by gastric cancer who received chemotherapy without occurrence of cardiotoxicity during the same period were selected as the non-occurrence group by 1∶1 ratio to the occurrence group.Left ventricular ejection fraction(LVEF),left atrial diameter(LAD),right atrial diameter(RAD),Tei index and NT-proBNP of the two groups were detected.The correlation of Tei index and NT-proBNP with cardiotoxicity of chemotherapy drugs was analyzed.Results The occurrence group had lower LVEF,but higher LAD and RAD,compared with those in the control group(P<0.05).There were no significant differences in Tei index and NT-proBNP level between the two groups before the first cycle of chemotherapy(all P>0.05).The occurrence group had lower Tei index and higher NT-proBNP level after the first,second,third and fourth cycles of chemotherapy,compared with those of the non-occurrence group(P<0.05).Results of Pearson analysis showed that Tei index was positively correlated with LVEF(r=0.612),but was negatively correlated with LAD(r=-0.643)and RAD(r=-0.695),all P<0.05.The NT-proBNP was negatively correlated with LVEF(r=-0.619),but was positively correlated with LAD(r=0.632)and RAD(r=0.684),all P<0.05.Conclusions Patients with gastric cancer complicated by coronary heart disease who have cardiotoxicity of chemotherapy drugs have poor cardiac function,and have abnormal Tei index and NT-proBNP level,which are closely related to the progression of chemotherapy cycle.The cardiotoxicity of chemotherapy drugs can be effectively evaluated according to Tei index and NT-probNP level.