基于3D-STI运用心肌综合指数评价蒽环类药物对乳癌患者的心肌毒性被引量：5

Evaluation of cardiotoxicity after receiving anthracycline in patients with breast cancer by using myocardial composite index based on 3D-STI

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摘要目的采用实时三维斑点追踪成像技术(3D-STI)检测左室心肌应变及扭转,计算心肌综合指数(MCI),研究其监测乳癌患者术后蒽环类药物化疗所致早期心肌毒性的临床价值。方法追踪观察拟行6周期乳癌术后蒽环类化疗的患者51例,在进行化疗前及化疗3周期、化疗6周期后的1~2 d内,分别检查二维超声心动图和3D-STI。应用后者获得左室整体面积应变、整体纵向应变、整体径向应变、整体圆周应变及左心室扭转,计算左心室MCI,比较各组间参数的统计学差异,利用受试者工作特征曲线评价左室三维应变参数、扭转及MCI对诊断心脏毒性的应用价值。征集20例健康女性作为对照组。结果 MCI在化疗第3周期、第6周期均较对照组、化疗前组明显减低(P<0.05),受试者工作特征曲线显示,MCI的曲线下面积为0.951,以-235.75(%×°)为截断值判断蒽环类药物对左室心肌功能损害时,其特异度为90.2%,敏感度为94.1%。结论 MCI在监测蒽环类化疗药物心肌损害方面具有较高的特异度和敏感度,3DSTI可早期检出乳癌患者术后蒽环类化疗药物所致的心肌损害,为临床提供了可靠的监测方法。 Objective To explore the clinical value of myocardial composite index （MCI） in the evaluation of early cardiotoxicity in breast cancer patients after receiving chemotherapy by using three dimensional speckle tracking imaging （3D-STI）. Methods A total of 51 patients of breast cancer postoperative to receive a six cycles of chemotherapy and 20 healthy females as control group were enrolled in this study. Routine echocardiography and 3 D-STI parameters were monitored before chemotherapy and during 24 -48 hours after receiving 3 and 6 cycles of chemotherapy. The global area strain, global longitudinal strain, global radial strain, global circumferential strain, Left ventricular twist were obtained by 3D-STI, to calculate the left ventricular myocardial syndrome and compare the statistical differences between the above parameters of each group, to use the receiver operating characteristic curve to evaluate the clinical value of the above parameters in diagnosis of cardiac toxicity. Results MCI after 3 and 6 cycles of chemotherapy was significantly lower than that of chemotherapy and control group （P 〈 0. 05 ）. The area under the receiver operating characteristic curve of MCI was 0. 951, and the cutoff value was - 235.75 （ % x °） , with a specificity of 90. 2% and a sensitivity of 94. 1%. Conclusion The sensitivity and specificity of MCI in the detection of anthracycline cardiotoxicity are high in the course of chemotherapy, and 3D-STI is a reliable method to detect the early damage of left ventricular myocardium in patients with breast cancer receiving anthracycline.

作者许芳芳郑慧胡莉莉陈娜周旺李朝密杨筱威

机构地区安徽医科大学第一附属医院超声科安徽医科大学第一附属医院乳腺外科

出处《安徽医科大学学报》 CAS 北大核心 2018年第1期146-151,共6页 Acta Universitatis Medicinalis Anhui

基金安徽省公益性研究联动计划项目(编号:1604f0804027)

关键词三维斑点追踪显像蒽环类化疗心肌综合指数应变扭转 three-dimensional spot tracking imaging anthracycline chemotherapy myocardial comprehensive index strain twist

分类号 R734.2 [医药卫生—肿瘤] R445.1 [医药卫生—影像医学与核医学]

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