摘要
目的探讨基于左室无创压力-应变环(PSL)技术在评估不同化疗方案(蒽环类与靶向治疗)对乳腺癌患者中心肌做功损害的临床价值。方法选取2022年10月~2024年9月本院收治的61例乳腺癌术后化疗患者,其中31例接受多柔比星/表柔比星(110 mg/m^(2))+环磷酰胺+多西他赛方案化疗(蒽环组),30例接受赫赛汀方案化疗(靶向组),另选取31例同期健康女性作为对照组。分别于化疗前(T0)和第4~6周期(T4)行超声心动图检查,测量常规超声心动图参数、整体纵向应变(GLS)及心肌做功参数,包括整体做功效率(GWE)、整体无用功(GWW)、整体有用功(GCW)和整体做功指数(GWI),比较各组间及不同时间点参数变化。结果3组年龄、心率、舒张压、收缩压、BMI、体表面积、常规超声参数、GLS及心肌做功参数的差异均无统计学意义(P>0.05)。T4期时,各组左心室舒张末期容积、左心室收缩末期容积、左心室射血分数、二尖瓣口血流A峰、E峰、E/A比值、二尖瓣环舒张早期平均速度(平均e′)、E/平均e′比值等常规超声参数与T0期相比差异无统计学意义(P>0.05),组间差异亦无统计学意义(P>0.05)。GLS在组内及组间的差异均无统计学意义(P>0.05)。但T4期时,蒽环组与靶向组的GWW均升高,GWE、GCW和GWI均下降(P<0.05),且两组间上述参数差异无统计学意义(P>0.05)。结论左室PSL技术可有效评估乳腺癌患者接受靶向治疗及蒽环类药物化疗后的心肌做功的变化,为早期临床干预提供参考依据。
Objective To evaluate differences in myocardial work impairment between anthracycline-based and targeted therapy in breast cancer patients using noninvasive left ventricular pressure-strain loop analysis.Methods Sixty-one postoperative breast cancer patients were enrolled in our hospital from October 2022 to September 2024,including 31 receiving doxorubicin/epirubicin(110 mg/m^(2))+cyclophosphamide+docetaxel(anthracycline group)and 30 receiving Herceptin-based regimen(targeted group).Thirty-one healthy women served as controls.Echocardiography was performed at baseline(T0)and after 4-6 chemotherapy cycles(T4).Conventional echocardiographic parameters,global longitudinal strain and myocardial work parameters were measured.The myocardial work parameters included global work efficiency(GWE),global wasted work(GWW),global constructive work(GCW),and global work index(GWI).Changes in these parameters were compared within and between groups at T0 and T4.Results No significant differences were observed in age,heart rate,diastolic blood pressure,systolic blood pressure,body mass index,body surface area,conventional echocardiographic parameters,global longitudinal strain and myocardial work parameters among the three groups(P>0.05).No statistically significant changes were found in left ventricular end-diastolic volume,left ventricular end-systolic volume,left ventricular ejection fraction,mitral inflow A-wave,E-wave,E/A ratio,average early diastolic mitral annular velocity(mean e′),or E/mean e′ratio between T0 and T4 in either patient group(P>0.05),and inter-group comparisons also showed no significant differences(P>0.05).Global longitudinal strain did not change significantly within or between groups(P>0.05).However,at T4,GWW significantly increased,while GWE,GCW,and GWI significantly decreased in both the anthracycline and targeted therapy groups(P<0.05).There were no significant differences in these parameters between the two groups(P>0.05).Conclusion The left ventricular pressure-strain loop technique can effectively evaluate changes in myocardial work in breast cancer patients following targeted therapy or anthracycline-based chemotherapy,providing a reference for early clinical intervention.
作者
姚婉丽
盛宗祥
冉红
任俊怡
陈文琴
张平洋
YAO Wanli;SHENG Zongxiang;RAN Hong;REN Junyi;CHEN Wenqin;ZHANG Pingyang(Department of Cardiovascular Ultrasound,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《分子影像学杂志》
2025年第12期1532-1537,共6页
Journal of Molecular Imaging
基金
南京市卫生科技发展专项重点项目(ZKX23032)。
关键词
左室压力-应变环
乳腺癌
靶向治疗
蒽环类药物化疗
心肌做功
left ventricular pressure-strain loop
breast cancer
targeted therapy
anthracycline chemotherapy
myocardial work
