斑点追踪技术联合血清高敏肌钙蛋白测定评价胃肠癌化疗患者心脏功能的改变

Evaluation of cardiac function injury in patients with gastrointestinal cancer treated with chemotherapy by speckle tracking technique combined with serum hypersensitive troponin

目的应用斑点追踪技术联合血清高敏肌钙蛋白测定评价胃肠癌患者应用FOLFOX(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗前后的心脏功能损伤情况。方法选取30例健康志愿者为正常组,另选择2020年1月至2021年3月我院收治的采用FOLFOX方案进行化疗的38例胃肠癌患者作为研究对象,采用自身对照的方式进行研究,于化疗前、化疗第2、4、6个周期结束后用斑点追踪评价患者的左心室纵向心肌应变,并于化疗前、化疗第2、4、6个周期结束后(24~48 h内)分别进行高敏肌钙蛋白的测定。结果化疗开始后,患者LVEDV在第4、6周期结束后有明显降低,分别为(92.45±10.11)ml、(74.86±10.07)ml;LVEF在第4、6周期结束后有明显降低,分别为(61.50±1.14)%、(58.36±1.08)%,较化疗前有统计学意义(P<0.05);LVFS在第4、6周期结束后有明显降低,分别为(37.50±2.25)%、(36.19±2.16)%,较化疗前有统计学意义(P<0.05);而其他常规左室超声心动图参数变化不明显;患者左室收缩期纵向应变在化疗前、化疗2周期、4周期、6周期后分别为(21.42±1.63)%、(19.76±1.41)%、(18.31±1.27)%、(17.69±1.09)%,随着化疗周期的增加纵向应变降低幅度更加明显(P<0.05);化疗第2、4、6个周期结束后患者高敏肌钙蛋白依次升高,分别为(4.04±0.77)pg/ml、(5.73±0.83)pg/ml、(7.69±0.89)pg/ml,较化疗前(2.67±0.64)pg/ml比较有统计学意义(P<0.05)。肌钙蛋白与左心室整体纵向应变呈负相关(r=-0.535,P<0.05)。结论斑点追踪技术联合血清高敏肌钙蛋白测定能够在胃肠癌化疗患者EF出现改变前预测患者心肌功能受损情况,并且血清高敏肌钙蛋白随着左心室整体纵向应变的降低而升高,对临床有一定的指导意义。

Objective To evaluate the damage of cardiac function in patients with gastrointestinal cancer before and after FOLFOX(5-fluorouracil+oxaliplatin+calcium folinate)chemotherapy.Methods 30 healthy people were selected as normal group.38 patients with gastrointestinal cancer treated with FOLFOX regimen in our hospital from January 2020 to March 2021 were selected as the research object.The study was carried out in a self-control way.After the second,fourth and sixth cycles of chemotherapy,the myocardial strain of the patients was evaluated by speckle tracking.After the second,fourth and sixth cycles of chemotherapy,serum hypersensitive troponin(hs-CTNI)testing were applied.Results After chemotherapy,LVEDV was significantly decreased at the end of the 4th and 6th cycles(92.45±10.11 ml and 74.86±10.07 ml,respectively);LVEF was significantly decreased at the end of the 4th and 6th cycles(61.50±1.14%and 58.36±1.08%,respectively);LVFS was significantly decreased at the end of the 4th and 6th cycles(37.50±2.25%,36.19±2.16%,respectively)compared with that before chemotherapy(P<0.05).Other conventional left ventricular echocardiography parameters did not change significantly.The longitudinal strain of left ventricular systole(GLS)was(21.42±1.63)%,(19.76±1.41)%,(18.31±1.27)%and(17.69±1.09)%before chemotherapy,after 2 cycles,4 cycles and 6 cycles of chemotherapy,respectively.The longitudinal strain decreased more significantly with the increase of chemotherapy cycles(P<0.05).After the second,fourth and sixth cycles of chemotherapy,the hypersensitive trhypersensitiveoponin of patients increased successively,which were(4.04±0.77)pg/ml,(5.73±0.83)pg/ml and(7.69±0.89)pg/ml,respectively,compared with(2.67±0.64)pg/ml before chemotherapy(P<0.05).The hypersensitive troponin was negatively correlated with the global longitudinal strain of left ventricle(r=-0.535,P<0.05).Conclusions Speck tracking combined with serum hypersensitive troponin measurement can predict the impaired myocardial function of patients with gastrointestinal cancer chemotherapy before the change of EF,and the high-sensitivity troponin increased with the decrease of the overall longitudinal strain of the left ventricle.which has certain guiding significance for clinical practice.