三维斑点追踪超声心动图评估急性淋巴细胞白血病患者化疗前的心功能与影响因素

Evaluation of Cardiac Function and Influencing Factors in Patients with Acute Lymphoblastic Leukemia Before Chemotherapy Using Three-Dimensional Speckle Tracking Echocardiography

目的应用三维斑点追踪超声心动图(3D-STE)评估成年急性淋巴细胞白血病(ALL)患者化疗前是否存在潜在的心肌损伤,并探究其影响因素。方法选择50例首次临床诊断为ALL的患者作为ALL组,并纳入30例健康体检者作为对照组,其年龄和性别均与ALL组匹配。对所有研究对象行超声心动图检查,测量左室的各项常规超声和3D-STE功能指标。比较ALL组与对照组临床资料、常规超声心动图各指标及3D-STE应变参数的差异;绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),选择GLS的最佳截断值并计算诊断效能;采用Pearson相关分析评估ALL患者的实验室指标和心功能与左室整体纵向应变(GLS)的相关性;采用同类相关系数法检验3D-STE参数在观察者内及观察者间一致性。结果ALL组和对照组的临床指标和常规左室功能参数差异无统计学意义(P>0.05),ALL组与对照组间的左室舒张末容积(EDV)、左室收缩末容积(ESV)、左室每搏输出量(SV)、左室整体圆周应变(GCS)以及左室整体径向应变(GRS)差异无统计学意义(P>0.05),ALL组的GLS低于对照组(P<0.05)。GLS诊断ALL的AUC为0.663(P=0.015),最佳截断值为-23.5%,敏感度为0.64,特异度为0.60。GLS与血红蛋白水平呈中等强度正相关(r=0.343,P=0.015),与C反应蛋白(CRP)呈较弱的正相关性(r=0.289,P=0.042),与血液淋巴细胞计数呈中等强度负相关(r=-0.434,P=0.002),与心肌肌钙蛋白(cTnI)、白介素-6(IL-6)和左室射血分数(LVEF)无相关性(r=-0.083、-0.276、0.268,P=0.569、0.052、0.060)。各项3D-STE测量指标在观察者内和观察者间具有良好的一致性,均符合同类相关系数>0.75。结论ALL患者的左室GLS受损早于LVEF降低,且与血液中淋巴细胞计数、血红蛋白水平和CRP独立相关,对ALL患者化疗前的心功能损伤具有预测价值。

Objective To evaluate the potential myocardial injury in adult acute lymphoblastic leukemia(ALL)patients before chemotherapy using three-dimensional speckle tracking echocardiography(3D-STE)and explore its related influencing factors.Methods A total of 50 patients with initial clinical diagnosis of ALL were selected as ALL group,and 30 healthy examination subjects were included as control group,both age and sex matched to the ALL group.The study subjects underwent routine echocardiography and 3D-STE to measure various functional indicators of the left ventricle.The clinical data,conventional echocardiographic parameters,as well as 3D-STE strain indicators between ALL group and control group were compared.The receiver operating characteristic(ROC)curve was protracted and the area under the curve(AUC)was calculated,the optimal cut off value for GLS was selected,and the diagnostic performance for ALL was calculated.Pearson correlation analysis was adopted to investigate the correlation between laboratory indicators and cardiac function with overall left ventricular global longitudinal strain(GLS)in ALL patients.Intraclass correlation coefficient method was chosen to test the consistency of 3D-STE parameters within and between observers.Results There were no differences in clinical parameters and conventional left ventricular function indicators between ALL group and control group(P>0.05).The left ventricular end diastolic volume(EDV),left ventricular end systolic volume(ESV),left ventricular stroke volume(SV),left ventricular global circumferential strain(GCS)as well as left ventricular global radial strain(GRS)were similar in the above two groups(P>0.05),while the GLS of ALL group was lower than that of control group(P<0.05).The AUC for GLS diagnosis of ALL was 0.663(P=0.015),with an optimal cutoff value of-23.5%,sensitivity of 0.64,and specificity of 0.60.GLS showed a moderate positive correlation with hemoglobin concentration(r=0.343,P=0.015),a weak positive correlation with C-reactive protein(CRP)(r=0.289,P=0.042),a moderate negative correlation with blood lymphocyte count(r=-0.434,P=0.002),and no significant correlation with cardiac troponin I(cTnI),interleukin-6(IL-6),and left ventricular ejection fraction(LVEF)(r=-0.083,-0.276,0.268,P=0.569,0.052,0.060,respectively).All 3D-STE measurement indicators have good repeatability within and between observers,all in line with intraclass correlation coefficient>0.75.Conclusion Left ventricular GLS damage in ALL patients occurs earlier than LVEF reduction,which is independently correlated with lymphocyte count,hemoglobin concentration,and CRP in the blood.It has predictive value for pre chemotherapy cardiac function damage in ALL patients.