摘要
目的:应用二维斑点追踪技术(2D-STI)应变和扭转技术检测乳腺癌(breast carcinoma患者使用多柔比星脂质体(DOX)化疗后的左心室心肌生物力学参数改变,探讨2D-STI评价和监测DOX化疗所致心脏功能损害的应用价值。方法:选择50例确诊初发乳腺癌并手术治疗住院患者及30例健康受试者。应用2D-STI检测正常对照组及DOX方案化疗,化疗前及化疗1～5疗程患者心脏整体纵向应变(GLS)、左室扭转角度(LVtw)等,计算GLS×LVtw值,分析比较乳腺术后化疗前后各心脏参数差异。结果:对照组及乳腺癌患者化疗前参数比较,差异均无统计学意义(P>0.05),化疗后GLS的绝对值较化疗前和对照组均下降,化疗后GLS×LVtw绝对值明显低于化疗前及对照组,差异均有统计学意义(P<0.01),化疗5个周期后超声指标符合心肌毒性诊断标准4例患者GLS、GLS×LVtw绝对值明显下降,以△GLS值-6.31%为截断点预测心肌毒性灵敏度、特异度分别为78%、89%;以△GLS×LVtw值-16.12%×°为截断点预测心肌毒性灵敏度、特异度分别为91%、60%。结论:传统超声不能检测DOX化疗所致早期心功能损害,2D-STI可以检测心肌应变和扭转技术特性早期改变,在早期检测化疗药物所致心功能损害方面敏感。
Objective:To assess the changes of left ventricle myocardial strain and twist by using 2D-STI (two dimension speckle tracking imaging),to study the value of strain and twist in monitoring early DOXinduced cardiotoxicity with aim of providing a more proper way in non-invasively predicting the early DOX-induced cardiotoxicity.Method:50 patients who were firstly diagnosed of breast carcinoma and 300 healthy volunteers without organic cardiac diseases were selected.The global longitudinal strain(GLS)and left ventricular torsion angle(LVtw)were measured by 2D-STI in normal control group and patients before and after chemotherapy with DOX regimen.The GLS × LVtw values were calculated and compared before and after chemotherapy with DOX regimen.Result:There was no significant difference in parameters between the control group and breast cancer patients before chemotherapy(P>0.05).The absolute value of GLS after chemotherapy was lower than that before chemotherapy and the control group.The results of GLS×LVtw after chemotherapy were significantly lower than those before chemotherapy and the control group(P<0.01).Ultrasound parameters of 4 patients who met the diagnostic criteria of myocardial toxicity after 5 cycles of chemotherapy were significantly lower than those before chemotherapy and the control group(P<0.01).The sensitivity and specificity of myocardial toxicity were 78% and 89% with △GLS value of -6.31% as the cut-off point,the sensitivity and specificity of myocardial toxicity were 91% and 60% with △GLS×LVtw value of -16.12%×° as the cut-off point. Conclusion:The traditional ultrasound can not detect early cardiac dysfunction caused by chemotherapy with DOX,2D-STI can detect early changes of left myocardium strain and twist properties with higher sensitive,it may become one of effective indicators in predicting secondary early myocardial toxicity after DOX chemotherapy.
出处
《中国医学创新》
CAS
2019年第13期6-10,共5页
Medical Innovation of China
基金
汕头市重点科技项目(汕市财教[2013]244号-71)
关键词
二维斑点追踪技术
乳腺癌
多柔比星脂质体
心脏毒性
左心室
心功能
Two dimension speckle tracking imaging
Breast carcinoma
Doxorubicin
Cardiotoxicity
Left ventricle
Cardiac function
