^(99m)Tc-MIBI心肌灌注断层显像监测蒽环类药物的心脏毒性

^(99m)Tc-MIBI myocardial perfusion tomography for monitoring the anthracycline cardiotoxicity

目的 :探讨99mTc-MIBI心肌灌注断层显像在蒽环类药物心脏毒性监测中的价值。方法 :2 3例接受蒽环类药物治疗的患者 ,在治疗前进行心电图、心肌酶学检查、核素心室造影测左室射血分数 (LVEF)和99mTc MIBI心肌灌注断层显像并计算相对定量值。并于每一周期治疗后重复上述检查。结果 :蒽环类药物治疗一周期后 ,2 3例患者心肌相对定量值明显下降 (P <0 .0 1)。其中 11例吡喃阿霉素、6例表阿霉素和 6例米托蒽醌治疗的患者 ,心肌相对定量值明显下降 (P <0 .0 5 ) ,心电图和心肌酶学无明显变化 (P >0 .0 5 )。蒽环类药物治疗多周期后的 10例患者心肌相对定量值较治疗前下降 (P <0 .0 5 )。 9例患者的心肌相对定量值 (最大累积剂量为 2 0 0mg/m2 )与一周期后无明显差别 (P >0 .0 5 )。10例患者治疗前及多周期治疗后LVEF均 >6 0 %,且化疗前后无明显差别 (P >0 .0 5 )。结论 :99mTC MIBI心肌灌注断层显像能监测蒽环类药物所致的心肌损害 ,且较左室射血分数敏感 ,比心电图和心肌酶学检查优越 ,有利于指导蒽环类药物的临床应用。

Objective To investigate the value of 99mTc-MIBI myocardial perfusion tomography monitoring the cardiotoxicity induced by anthracycline. Methods Twenty-three patients with anthracycline chemotherapy were examined by electrocardiogram(ECG),myocardial enzyme(CK-MB),nuclear angiography for detecting left ventricular ejection fraction(LVEF)and 99mTc-MIBI myocardial perfusion tomography for detecting myocardial relative quantity (MRQ).These examinations were repeated after every chemotherapy.Results The MRQ after one period of anthracycline chemotherapy was significantly lower than the pretherapy in 23 patients (P<0.01).The MRQ significantly decreased after one period of chemotherapy in 11 patients treated by pirarubicin,in 6 by epirubicin,and 6 by mitoxantrone (P< 0.05).There was not significant change in the mean value of ECG and CK-MB after one period of chemotherapy (P>0.05).After multiple-period anthracycline chemotherapy in 10 patients,a decrease was observed in MRQ (P<0.01).There was not significant difference in MRQ between multiple periods and one period therapy(P>0.05)and in LVEF in the period before and after multiple-period chemotherapy(P>0.05).Conclusion 99mTc-MIBI myocardial perfusion tomography can monitor the anthracycline cardiotoxicity and its changes are earlier than LVEF′s. 99mTC-MIBI myocardial perfusion tomography may be helpful to the clinical treatment for anthracycline.