分层应变技术联合左心室压力-应变环对儿童胸部霍奇金淋巴瘤放疗后心肌损伤的评估价值

Evaluation Value of Layered Strain Technique Combined with Left Ventricular Pressure-Strain Loop in Myocardial Injury After Thoracic Hodgkin’s Lymphoma in Children

目的 分析采用分层应变技术和左心室压力-应变环(PSL)对胸部霍奇金淋巴瘤(HL)患儿放疗后心肌损伤的评估价值。方法 抽取2020年1月至2022年12月河南省肿瘤医院接受放疗的胸部HL患儿52例,所有患儿均在放疗前进行PSL及分层应变技术检查,并于放疗后进行心肌标志物与影像学检查,统计儿童放疗后心肌损伤发生情况,并根据结果分为心肌损伤组与非心肌损伤组。比较心肌损伤组与非心肌损伤组患者的PSL检测参数[做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)]、分层应变技术检测参数[心外膜层收缩期纵向峰值应变(LPS-epi)、中层纵向收缩期峰值应变(LPS-mid)、心内膜层纵向收缩期峰值应变(LPS-endo)],采用点二列相关性分析PSL与分层应变技术检查与胸部HL患儿放疗后心肌损伤的相关性,并绘制受试者工作特征(ROC)曲线,分析分层应变技术联合PSL对患儿放疗后心肌损伤的评估价值。结果 经过检查后发现,52例胸部HL患儿中出现心肌损伤占比61.54%,未出现占比38.46%;心肌损伤组GWI、GCW、GWW与GWE低于非心肌损伤组(P<0.05);心肌损伤组LPS-epi、LPS-mid与LPS-endo高于非心肌损伤组(P<0.05);经点二列相关性分析显示,GWI、GCW、GWW、GWE与胸部HL患儿放疗后心肌损伤呈负相关(r<0,P<0.05),LPS-epi、LPS-mid、LPS-endo与胸部HL患儿放疗后心肌损伤呈正相关(r>0,P<0.05);绘制ROC曲线,结果显示,分层应变技术联合PSL对胸部HL患儿放疗后心肌损伤发生的曲线下面积>0.7,联合具有一定的评估价值。结论 分层应变技术联合PSL在胸部HL患儿放疗后心肌损伤情况中具有重要的临床评估价值,能够有效评估患儿心肌损伤情况,为临床患儿的防治提供依据。

Objective To analyze the evaluation value of layered strain technique and left ventricular pressure-strain loop(PSL)for postoperative myocardial injury in children with thoracic Hodgkin’s lymphoma(HL)after radiotherapy.Methods A total of 52 patients with chest HL who underwent radiotherapy at Henan Cancer Hospital from January 2020 to December 2022 were selected.All patients underwent PSL and layered strain technique examinations before radiotherapy,and myocardial biomarkers and imaging examinations were performed after radiotherapy.The incidence of myocardial injury in children after radiotherapy was statistically analyzed,and they were divided into myocardial injury group and non myocardial injury group based on the results.The PSL detection parameters[global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE)],layered strain technique detection parameters[longitudinal peak strain of epicardial(LPS-epi),longitudinal peak strain of midcardial(LPS-mid),longitudinal peak strain of endocardial(LPS-endo)]were compared between the myocardial injury group and the non myocardial injury group.The correlation between PSL and layered strain technique and myocardial injury after radiotherapy in children with chest HL was analyzed by point two column correlation,and the receiver operating characteristic(ROC)curve was drawn to analyze the evaluation value of layered strain technique combined with PSL on myocardial injury after radiotherapy in children.Results After examination,it was found that among 52 cases of chest HL,61.54%had myocardial injury,while 38.46%did not.The GWI,GCW,GWW and GWE in the myocardial injury group were lower than those in the non myocardial injury group(P<0.05).The LPS-epi,LPS-mid and LPS-endo levels in the myocardial injury group were higher than those in the non myocardial injury group(P<0.05).Correlation analysis showed that GWI,GCW,GWW and GWE were negatively correlated with myocardial injury after radiotherapy in children with chest HL(r<0,P<0.05),and LPS-epi,LPS-mid and LPS-endo were positively correlated with myocardial injury after radiotherapy in children with chest HL(r>0,P<0.05).The ROC curve was plotted,and the results showed that the combination of layered strain technique and PSL had an area under curve greater than 0.7 for the occurrence of myocardial injury in children with chest HL after radiotherapy,which had certain evaluation value.Conclusion The combination of layered strain technique and PSL has important clinical evaluation value in the myocardial injury situation of children with chest HL after radiotherapy,which can effectively evaluate the myocardial injury situation of children and provide a basis for the prevention and treatment of clinical children.