超声心动图联合血清cTnI、GDF-15检测对老年乳腺癌患者术后化疗心脏损伤的评估价值

The value of echocardiography combined with serum cTnI and GDF-15in the evaluation of cardiac injury in elderly patients with breast cancer after chemotherapy

目的探究超声心动图联合血清心肌肌钙蛋白I(cTnI)、生长分化因子-15(GDF-15)对老年乳腺癌(BC)患者术后化疗心脏损伤的评估价值。方法选取北京市大兴区人民医院2019年9月至2022年8月收治的112例老年BC术后应用表柔比星为主的化疗患者为研究对象,按照是否发生心脏损伤将其分为:心脏损伤组(40例)和心脏未损伤组(72例)。评估超声心动图对老年BC患者术后化疗心脏损伤的诊断价值;采用酶联免疫吸附法检测两组血清cTnI、GDF-15水平;采用受试者工作特征曲线评估血清cTnI、GDF-15对老年BC患者术后化疗心脏损伤的诊断价值;以心脏损伤判定标准为金标准,评价超声心动图、血清cTnI、GDF-15及三者联合对老年BC患者术后化疗心脏损伤的诊断价值。结果超声心动图诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为77.50%、88.89%、84.82%;心脏损伤组患者血清cTnI、GDF-15水平均明显高于心脏未损伤组(P<0.05);血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的曲线下面积分别为0.864、0.834,截断值分别为221.88 ng/L、8.06 ng/L,灵敏度分别为75.00%、80.00%,特异度分别为94.44%、87.50%,准确度分别为87.50%、84.82%;超声心动图联合血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为97.50%、86.11%、90.18%,优于单独诊断。结论超声心动图联合血清cTnI、GDF-15对老年BC患者术后化疗致心脏损伤有较高诊断价值,可有效提高灵敏度、准确度,具有较高特异度。

Objective To explore the value of echocardiography combined with serum cardiac troponin I(cTnI)and growth differentiation factor-15(GDF-15)in evaluating cardiac injury after chemotherapy in elderly patients with breast cancer(BC).Methods A total of 112elderly BC patients who received epirubicin based chemotherapy from September 2019to August 2022in Beijing Daxing District People's Hospital were selected as the research objects,and they were divided into heart injury group(40cases)and non heart injury group(72cases)according to whether heart injury occurred.The diagnostic value of echocardiography in elderly BC patients with postoperative chemotherapy heart injury was evaluated;the levels of serum cTnI and GDF-15were detected by enzyme-linked immunosorbent assay;receiver operating characteristic curve was used to evaluate the diagnostic value of serum cTnI and GDF-15in elderly BC patients with postoperative chemotherapy induced cardiac injury.The diagnostic criteria for cardiotoxicity was used as the gold standard,and the diagnostic value of echocardiography,serum cTnI,GDF-15and their combination in elderly BC patients with postoperative chemotherapy heart injury was analyzed.Results The sensitivity,specificity and accuracy of echocardiography in the diagnosis of postoperative cardiac injury after chemotherapy in elderly BC patients were 77.50%,88.89%and 84.82%,respectively;the levels of serum cTnI and GDF-15in heart injury group were significantly higher than those in non heart injury group(P<0.05);the area under curve of serum cTnI and GDF-15in the diagnosis of cardiac injury after postoperative chemotherapy in elderly patients with BC were 0.864and 0.834,the cut-off values were 221.88ng/L and 8.06ng/L,the sensitivity were 75.00%and 80.00%,the specificity were 94.44%and 87.50%,the accuracy were 87.50%and 84.82%,respectively;the sensitivity,specificity and accuracy of echocardiography combined with serum cTnI and GDF-15in the diagnosis of cardiac injury after chemotherapy in elderly patients with BC were 97.50%,86.11%and 90.18%,respectively,which were better than that of single diagnosis.Conclusion Echocardiography combined with serum cTnI and GDF-15has high diagnostic value for cardiac injury caused by postoperative chemotherapy in elderly BC patients,which can effectively improve the sensitivity,accuracy and has high specificity.