三维斑点追踪成像评价蒽环类药物化疗前后乳腺癌患者的心脏功能

发布时间：2018-04-11 04:27

本文选题：三维斑点追踪成像技术 + 蒽环类药物　；参考：《石河子大学》2017年硕士论文

【摘要】：目的应用超声三维斑点追踪成像技术评价蒽环类药物(anthracycline,ATC)化疗前后乳腺癌患者的心室功能,并探究左室、右室整体应变参数监测亚临床心脏毒性的临床价值。方法40例乳腺切除术后病理确诊乳腺癌患者,均采用以表柔比星为主的AC-T化疗方案(表柔比星+环磷酰胺,紫杉醇),且患者符合纳入标准。应用自身对照研究,分别于化疗前、化疗2个周期后、化疗4个周期后(24小时之内),行常规超声心动图及采集三维心室全容积动态图像,获取参数,并比较化疗前后所有参数的变化。结果与化疗前基础状态相比较,化疗第2周期后、化疗第4周期后左室的常规超声参数LVESV、LVEDV、LVEF、LVFS、IVSd、LVPWd差异均无统计学意义(P0.05);同样,与化疗前相比较,右室的常规超声参数RVD、TAPSE、S’、RVFAC差异均无统计学意义(P0.05)。化疗后左室GAS和GLS较化疗前明显减低(P0.05),与蒽环类药物累计剂量呈负向相关性,其中GAS的ROC曲线下面积为0.897,P=0.000,选-30.55%为诊断界点,灵敏度为0.857,特异度为0.917;化疗后右室GLS、GCS、GRS均较化疗前明显减低(P0.05),并且右室GLS早于GCS、GRS,对右室GLS行Spearman相关分析,其相关系数r=-0.700,P=0.000,两者呈显著负相关。结论三维斑点追踪技术可以早期发现蒽环类药物致乳腺癌患者左、右室心肌功能的损害,早期评估其亚临床心脏毒性,为临床早期干预提供依据。
[Abstract]:Objective to evaluate the ventricular function of breast cancer patients before and after chemotherapy with anthracycline ATC by using three dimensional ultrasonic speckle tracing imaging, and to explore the clinical value of global strain parameters of left ventricle and right ventricle in monitoring subclinical cardiac toxicity.Methods 40 patients with breast cancer diagnosed by pathology after mastectomy were treated with epirubicin AC-T chemotherapy regimen (epirubicin cyclophosphamide, paclitaxel), and the patients met the inclusion criteria.In the autocontrol study, the parameters were obtained by routine echocardiography and 3D dynamic images of ventricular volume before chemotherapy, 2 cycles after chemotherapy, and within 24 hours after 4 cycles of chemotherapy.The changes of all parameters before and after chemotherapy were compared.Results compared with the baseline state before chemotherapy, there was no significant difference in LVESVV, LVEVDVV, LVFSV, IVSdT, LVPWd, LVESVV, LVEDVV, LVSdT and LVPWd between the two groups after the second cycle of chemotherapy and the fourth cycle of chemotherapy (P 0.05), and there was no significant difference in LVPWd between LVESVV and LVEDVV after the fourth cycle of chemotherapy.There was no significant difference in RVFAC between RVDX and TAPSES (P 0.05).After chemotherapy, GAS and GLS in the left ventricle decreased significantly compared with those before chemotherapy, and there was a negative correlation with the cumulative dose of anthracyclines. The area under the ROC curve of GAS was 0.897, and the diagnostic threshold was -30.55%.Conclusion Three-dimensional speckle tracing technique can detect the myocardial function damage of left and right ventricle in patients with breast cancer caused by anthracyclines, and evaluate its subclinical cardiac toxicity early, and provide evidence for early clinical intervention.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R540.45

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