摘要
目的应用列线图探讨超声联合血清学指标早期预测乳腺癌术后化疗患者的心脏毒性。方法前瞻性选取在我院乳腺外科经术后病理确诊的乳腺癌女性患者148例,所有患者均于术后2周接受化疗,根据化疗1年后是否发生左室射血分数(LVEF)下降超过10%,将患者分为毒性组与无毒性组。比较两组患者化疗前与化疗3周期常规超声心动图指标、血清学指标及二维斑点追踪(2D-STI)指标差值的差异。采用多因素COX回归筛选预测心脏毒性的指标并建立列线图预测患者出现心脏毒性的概率。绘制受试者工作特征(ROC)曲线分析各指标评估术后早期心脏毒性风险的价值。结果共随访148例患者,失访2例,余146例患者纳入研究,其中毒性组18例,无毒性组128例。多因素COX回归显示化疗前与化疗3周期高敏感性心肌肌钙蛋白I差值(Δhs-cTnI)、N末端B型利钠肽前体差值(ΔNT-proBNP)和整体纵向峰值应变差值(ΔGLS)是预测乳腺癌术后化疗患者心脏毒性的独立风险指标(HR=1.030、1.003、1.853,均P<0.05)。基于Δhs-cTnI、ΔNT-proBNP和ΔGLS建立的列线图提示患者心脏毒性风险方面具有良好的辨别力(C-index=0.904)和校准度(χ2=8.170,P=0.417,Hosmer-Lemeshow检验)。ROC曲线分析结果显示,列线图预测患者发生心脏毒性风险的曲线下面积最高,为0.904。结论ΔGLS联合Δhs-cTnI、ΔNT-proBNP绘制的列线图有助于早期评估乳腺癌术后化疗患者发生心脏毒性的风险。
Objective To establish a nomogram model of ultrasound combined with serological indicators,and to explore its early prediction of cardiac toxicity in breast cancer patients undergoing postoperative chemotherapy.Methods A total of 148 female patients with breast cancer confirmed by pathology in our hospital were recruited.All patients were routinely administered with chemotherapy drugs 2 weeks after surgery,they were divided into toxic group and non-toxic group according to whether or not they experienced a decrease in left ventricular ejection fraction(LVEF)of more than 10%after 1 year of chemotherapy.The differences of routine echocardiographic indexes,serological indexes and two-dimensional speckle tracking imaging(2D-STI)indexes in the third chemotherapy cycle between the two groups were compared.Multivariate COX regression was used to screen the predictors of cardiotoxicity after postoperative chemotherapy,and the nomogram was established based on above predictors to predict the incidence of cardiotoxicity in breast cancer patients.Receiver operating characteristic(ROC)curve was drawn to analyze the value of each index in assessing the risk of early cardiotoxicity after postoperative chemotherapy.Results A total of 148 patients were followed up,and 2 patients were lost to follow-up.The remaining 146 patients were 18 cases in the toxic group and 128 cases in the non-toxic group.Multivariate COX regression showed that delta-high sensitive cardiac tropon(Δhs-cTnI),delta-N-terminal pro-B type natriuretic peptide(ΔNT-proBNP)and delta-global longitudinal strainΔGLS were independent risk indicators for predicting cardiotoxicity after postoperative chemotherapy in breast cancer patients(HR=1.030,1.003,1.853,all P<0.05).The nomogram established based onΔhs-cTnI,ΔNT-proBNP andΔGLS could be used to indicate the risk of cardiotoxicity,and had good discrimination(C-index=0.904)and calibration(χ2=8.170,P=0.417,Hosmer-Lemeshow test).ROC curve showed that the nomogram had the highest value in predicting the risk of cardiotoxicity(area was 0.904).Conclusion The nomogram model established byΔhs-cTnI andΔNT-proBNP is helpful for the early assessment of the risk of cardiotoxicity in breast cancer patients undergoing postoperative chemotherapy.
作者
李英华
郭强
蒋金全
曾军
崔文婷
刘怡
笪应芬
LI Yinghua;GUO Qiang;JIANG Jinquan;ZENG Jun;CUI Wenting;LIU Yi;DA Yingfen(Department of Ultrasound,Huangpu Branch of Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)
出处
《临床超声医学杂志》
CSCD
2021年第8期570-575,共6页
Journal of Clinical Ultrasound in Medicine
基金
上海市卫生健康委员会卫生行业临床研究专项计划(201940189)。
