摘要
目的探讨三维斑点追踪成像(3D-STI)监测HER2阳性乳腺癌患者靶向治疗后心功能变化的临床价值,以及评估早期心肌损害的有效方法。方法选择2018年3月至2021年2月于解放军总医院第七医学中心首次接受曲妥珠单抗靶向治疗的HER2阳性乳腺癌患者65例。根据年龄分组,<60岁为A组(n=34),≥60岁为B组(n=31)。检测两组患者治疗前及治疗3月、6月、12月和治疗结束后6月的三维斑点追踪显像参数左室整体纵向应变(LVGLS)、二维超声心动图左室射血分数(LVEF),血清心肌损伤指标心肌肌钙蛋白Ⅰ(cTnI),N末端脑钠肽前体(NT-pro BNP)和肌酸激酶同工酶(CK-MB)质量。分别比较组间及组内不同时间的参数,采用Pearson检验评估LVGLS与cTnI的相关性。结果治疗前,两组患者的LVGLS、LVEF及cTnI、NT-proBNP和CK-MB水平比较,差异无统计学意义(P>0.05)。治疗12月,B组LVEF值较治疗前减低。治疗3月、6月、12月,B组LVGLS值较治疗前逐渐减低;B组LVGLS水平低于A组。治疗3月、6月、12月,B组cTnI、NT-proBNP、CK-MB水平较治疗前逐渐增高;B组cTnI、NT-pro BNP、CK-MB水平高于A组。与治疗12月的参数比较,治疗后6月,两组LVGLS增高,cTnI、NT-proBNP、CK-MB水平均减低。三维斑点追踪参数LVGLS与血清心肌损伤指标cTnI呈负相关(r=-0.82,P<0.05)。结论三维斑点追踪参数LVGLS能早期检测HER2阳性乳腺癌患者靶向治疗后的心肌损伤,客观反映心肌损伤程度,与血清心肌损伤指标水平相关。3D-STI在监测靶向药物治疗HER2阳性乳腺癌患者的早期心脏毒性具有临床价值。
Objective To investigate the clinical value of three-dimensional speckle tracking imaging(3D-STI)in monitoring myocardial injury in patients with HER2 positive breast cancer after target treatment,and effective methods for reviewing early myocardial injury.Methods The patients with HER2 positive breast cancer(n=65)received firstly trastuzumab target treatment were chosen from the Seventh Medical Center of Chinese PLA General Hospital from Mar.2018 to Feb.2021.The patients were divided,according to age,into group A(aged<60,n=34)and group B(aged≥60,n=31).The parameters of 3D-STI including left ventricularglobal longitudinal strain(LVGLS)and left ventricular ejection fraction(LVEF)of two-dimensionalechocardiogram,and indexes of myocardial injury including cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP)and creatine kinase-MB isoenzyme(CK-MB)were detected in 2 groups before treatment,treatment for 3,6 and 12 months and 6 months after treatment.The parameters were compared between groups and within the same group.The correlated between LVGLS and cTnI was reviewed by using Pearson test.Results Before treatment,the differences in values of LVGLS and LVEF and levels of cTnI,NT-proBNP and CK-MB had no statistical significance between 2 groups(P>0.05).The value of LVEF decreased in group B treated for 12 months.The value of LVGLS decreased gradually in group B,and was lower in group B than that in group A treated for 3,6 and 12 months.The levels of cTnI,NT-proBNP and CK-MB increased gradually in group B,and were higher in B than those in group A treated for 3,6 and 12 months.Compared with parameters in treatment for 12 months,the value of LVGLS increased,and levels of cTnI,NT-proBNP and CK-MB decreased in 2 groups 6 months after treatment.LVGLS was negatively correlated to cTnI(r=-0.82,P<0.05).Conclusion LVGLS,a 3D-STI parameter,can early detect myocardial injury in patients with HER2 positive breast cancer after target treatment,reflect objectively severity of myocardial injury,and is correlated to indexes of myocardial injury.3D-STI has clinical value in monitoring early cardiotoxicity in patients with HER2 positive breast cancer.
作者
牛海燕
崔振双
宋瑾
宋青
曹旭峰
Niu Haiyan;Song Jin;Cui Zhenshuang;Song Qing;Cao Xufeng(Department of Ultrasonic Diagnosis,Seventh Medical Center,Chinese PLA General Hospital,Beijing 100700,China;不详)
出处
《中国循证心血管医学杂志》
2024年第7期826-829,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
中国博士后科学基金(2020T130778)。
关键词
三维斑点追踪成像
乳腺癌
靶向治疗
心肌损伤
Three-dimensional speckle tracking imaging
Breast cancer
Target treatment
Myocardial injury
