三维斑点追踪技术评估乳腺癌患者蒽环类药物治疗引起心脏毒性的价值

Value of three-dimensional speckle tracking in the evaluation of cardiotoxicity induced by anthracycline in breast cancer patients

目的 探讨三维斑点追踪技术评估乳腺癌患者蒽环类药物治疗引起心脏毒性的临床价值。方法 50例行蒽环类药物治疗的乳腺癌患者根据不同给药时间点和药物总剂量分组:A组(给药前,药物总剂量0)、B组(给药中,药物总剂量180 mg/m~2)、C组(给药后,药物总剂量360 mg/m~2),另选同期体检健康女性50例为对照组;各组均行二维超声心动图和三维斑点追踪技术检查,比较各组左室后壁厚度(LVPWd)、室间隔厚度(IVSd)、左室舒张末期内径(LVIDd)、左室射血分数(LVEF)、球形指数(SPI)、左室收缩末期质量(ESmass)、左室舒张末期质量(EDmass)、心输出量(CO)、左室扭转角度峰值(LVtw)、整体圆周应变(GCS)、整体径向应变(GRS)、整体纵向应变(GLS)、整体面积应变(GAS)、心肌综合指数(MCI)的差异。绘制受试者工作特征(ROC)曲线分析各参数评估乳腺癌患者蒽环类药物治疗引起心脏毒性的效能。结果 二维超声心动图检查结果显示,各组LPVWd、IVSd、LVIDd及LVEF比较差异均无统计学意义。三维斑点追踪技术检查结果显示,各组LVEF、LVtw、GCS、GRS、GLS、GAS、MCI比较差异均有统计学意义(均P<0.05),C组LVEF、LVtw、GLS、GAS及MCI均低于A、B组和对照组(均P<0.05),GRS低于A组和对照组,差异均有统计学意义(均P<0.05)。B组LVtw、GLS、GAS及MCI均低于A组和对照组,差异均有统计学意义(均P<0.05)。各组SPI、ESmass、EDmass、CO比较差异均无统计学意义。ROC曲线分析显示,LVEF、LVtw、GCS、GRS、GLS、GAS、MCI评估乳腺癌患者蒽环类药物治疗引起心脏毒性的曲线下面积分别为0.652、0.874、0.625、0.583、0.830、0.916和0.949。结论 三维斑点追踪技术能准确评估乳腺癌患者蒽环类药物治疗引起的心脏毒性,可为临床制定治疗方案提供参考,具有较好的临床应用价值。

Objective To investigate the clinical value of three-dimensional speckle tracking imaging in the evaluation of cardiotoxicity induced by anthracyclines in breast cancer patients.Methods Fifty patients with breast cancer were treated with anthracycline,according to different administration time points and total drug doses,they were divided into three groups:group A(before administration,total anthracycline dose 0),group B(during administration,total anthracycline dose180 mg/m~2)and group C(after administration,total anthracycline dose 360 mg/m~2).50 healthy women during the same period were selected as control group.All patients were examined by two-dimensional echocardiography and three-dimansional speckle tracking imaging,the differences of left ventricular posterior wall thickness(LVPWd),interventricular septal thickness(IVSd),left ventricular end-diastolic diameter(LVIDd),left ventricular ejection fraction(LVEF),spherical index(SPI),left ventricular end-systolic mass(ESmass),left ventricular end-diastolic mass(EDmass),cardiac output(CO),left ventricular twist(LVtw),global circumferential strain(GCS),global radial strain(GRS),global longitudinal strain(GLS),global area strain(GAS)and myocardial composite index(MCI)in each group were evaluated.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of each parameter in evaluating the cardiotoxicity induced by anthracyclines in breast cancer patients.Results The results of two-dimensional echocardiography showed that there were no significant differences in LPVWd,IVSd,LVIDd and LVEF among all groups.The results of three-dimensional speckle tracking technology showed that LVEF,LVtw,GCS,GRS,GLS,GAS and MCI were significantly different among all groups(all P<0.05),LVEF,LVtw,GLS,GAS and MCI in group C were significantly lower than those in group A,group B and control group,and GRS was lower than that in group A and group B,the differences were statistically significant(all P<0.05).While LVtw,GLS,GAS and MCI in group B were significantly lower than those in group A and control group,the differences were statistically significant(all P<0.05).GRS in group C was also significantly lower than that in group A,and the differences were statistically significant(all P<0.05).There were no significant difference in SPI,ESmass,EDmass,CO among all groups.ROC curve analysis showed that the area under the curve of LVEF,LVtw,GCS,GRS,GLS,GAS and MCI were 0.652,0.874,0.625,0.583,0.830,0.916 and 0.949,respectively.Conclusion Threedimensional speckle tracking imaging can accurately evaluate the carditoxicity induced by anthracycline in breast cancer patients,which can provide reference for clinical treatment and has good clinical application value.