二维斑点追踪技术在评价蒽环类药物治疗恶性淋巴瘤继发心功能损害中的应用

发布时间：2018-01-30 13:30

本文关键词： 二维斑点追踪技术应变蒽环类药物心脏毒性心功能扭转　出处：《吉林大学学报(医学版)》2017年06期 　论文类型：期刊论文

【摘要】：目的:应用二维斑点追踪技术(2D-STI)检测非霍奇金淋巴瘤(NHL)患者使用蒽环类药物(ANTH)化疗后的左室心肌组织生物力学参数改变,探讨2D-STI评价和监测ANTH化疗所致心脏功能损害的价值。方法:选择NHL初发住院患者37例(ANTH化疗组,行CHOP方案化疗)及与之相匹配的健康受试者20人(正常对照组)。采用2D-STI检测正常对照组和ANTH化疗组受试者化疗前及化疗第1、2和3个周期患者心脏整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)及左室扭转角度(LVtw),计算对应的GLS×LVtw值。结果:正常对照组受试者和ANTH化疗组患者化疗前一般临床参数比较差异无统计学意义(P0.05);ANTH化疗组患者化疗后GLS、GRS及GCS低于化疗前和正常对照组(P0.05),GLS下降幅度较GRS和GCS明显;化疗第3个周期超声指标符合心肌毒性诊断标准的4例患者的GLS、GRS、GCS、GLS×LVtw降低;以△GLS×LVtw=-64.53%×°为截断点预测发生心肌毒性的灵敏度为94%,特异度为66.7%,约登指数最大为0.667。结论:2D-STI可以检测左室心肌组织生物力学参数的早期改变,在早期检测ANTH所致心功能损害方面较敏感,可能成为未来预测ANTH化疗继发早期心肌毒性的有效方法。
[Abstract]:Objective: to detect the biomechanical parameters of left ventricular myocardium in patients with non-Hodgkin 's lymphoma (NHL) after chemotherapy with anthracycline (ANTHs) by two dimensional dot tracing technique (2D-STI). To evaluate the value of 2D-STI in evaluating and monitoring cardiac dysfunction induced by ANTH chemotherapy. Methods: 37 patients with NHL were treated with ANTH chemotherapy. CHOP regimen chemotherapy) and matched 20 healthy subjects (normal control group). 2D-STI was used to detect the subjects of normal control group and ANTH chemotherapy group before chemotherapy and chemotherapy 1. In 2 and 3 cycles, the global longitudinal strain of the heart, the global radial strain, the global circumferential strain and the left ventricular torsion angle were observed. Results: there was no significant difference in general clinical parameters between the normal control group and the ANTH chemotherapy group before chemotherapy. GRS and GCS in ANTH group were significantly lower than those in GRS and GCS before chemotherapy and in normal control group. GLS 脳 LVtw were decreased in 4 patients who met the criteria of myocardial toxicity in the 3rd cycle of chemotherapeutic ultrasound. The sensitivity and specificity of GLS 脳 LVtw-64.53% 脳掳for predicting myocardial toxicity were 94 and 66.7% respectively. The maximum Jordan index was 0.667.Conclusion the weight 2D-STI can detect the early changes of the biomechanical parameters of left ventricular myocardium and is sensitive to the early detection of cardiac function damage caused by ANTH. It may be an effective method for predicting early myocardial toxicity secondary to ANTH chemotherapy in the future.
【作者单位】：中山大学附属汕头医院超声科;
【基金】：广东省卫计委医学科研基金资助课题(A2010584)
【分类号】：R445.1;R733
【正文快照】： 蒽环类药物(anthracycline,ANTH)是一类抗瘤谱广、抗瘤作用强、疗效确切的抗肿瘤药物,广泛应用于实体性肿瘤和血液系统肿瘤的化疗,其最主要和最严重的毒副作用是心脏毒性。目前,临床监测心脏毒性的方法众多,包括心电图、血清学检查、超声心动图、磁共振成像(MRI)以及心内膜心

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