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左室压力-应变环评价乳腺癌患者化疗后心肌损害的应用研究

Application of left ventricular pressure-strain loop in evaluating myocardial damage after chemotherapy in patients with breast cancer

    摘要
  • 摘要:
      目的  应用左室压力-应变环(PSL)评价乳腺癌患者采用蒽环类药物化疗后对心肌损害的影响。
      方法  选取40例已行手术治疗的乳腺癌患者纳入研究组，给予以表柔比星为主的蒽环类药物化疗，另选取同期体检的40名健康人员纳入对照组。研究组(化疗前、化疗2个周期后、化疗4个周期后)和对照组均分别进行常规超声、二维斑点追踪超声心动图、PSL检查，获得左心室射血分数(LVEF)、左心室缩短分数(FS)、左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、左心室每搏量(SV)、左心室整体纵向应变(GLS)、左室整体做功指数(GWI)、左心室整体有效功(GCW)、左心室整体无效功(GWW)、左心室整体做功效率(GWE)参数，评价乳腺癌患者化疗后心肌损害情况。
      结果  研究组化疗前GLS、GWI、GCW、GWW、GWE与对照组比较，差异无统计学意义(P > 0.05)。研究组化疗2、4个周期后的GWI、GCW、GLS低于化疗前及对照组，差异有统计学意义(P < 0.05); 研究组化疗2、4个周期后的GWW、GWE与化疗前及对照组比较，差异无统计学意义(P > 0.05)。研究组化疗2、4个周期后的常规超声心动图参数LVEF、FS、EDV、ESV与化疗前及对照组比较，差异均无统计学意义(P > 0.05)。GLS与GWI、GCW均呈正相关(r=0.582、0.433, P < 0.05); GLS与GWW、GWE均无相关性(r=0.168、0.299, P > 0.05)。
      结论  PSL可良好地评价乳腺癌患者化疗后的早期心脏毒性。

     

    Abstract:
      Objective  To investigate the effect of left ventricular pressure-strain loop(PSL) in evaluating myocardial damage caused by anthracycline chemotherapy in breast cancer patients.
      Methods  Forty breast cancer patients undergoing surgeries were selected, and were given chemotherapy by epirubicin-based anthracycline anticancer drug. Another 40 healthy people who underwent physical examinations during the same period were included in control group. Conventional ultrasound, two-dimensional speckle tracing imaging and PSL test were performed for breast cancer patients before chemotherapy, 2-cycle and 4-cycle of chemotherapy. The parameters included left ventricular ejection fraction(LVEF), left ventricular fraction shortening(FS), end-diastolic volume(EDV), end-shrinkage volume(ESV), left ventricular stroke volume(SV), left ventricular global longitudinal strain(GLS), left ventricular global work index(GWI), left ventricular global constructive work(GCW), left ventricular global work waste(GWW) and left ventricular global work efficiency(GWE) were obtained and myocardial damage was evaluated.
      Results  Before chemotherapy, GLS, GWI, GCW, GWW and GWE in the study group showed no statistically significant differences compared with the control group (P > 0.05). GWI, GCW, and GLS levels after 2-cycle and 4-cycle of chemotherapy were significantly lower compared with those before chemotherapy and the control group (P < 0.05), but GWW and GWE as well as conventional echocardiography parameters such as LVEF, FS, EDV and ESV showed no significant differences at the same time points compared with those before chemotherapy and the control group(P > 0.05). GLS was positively correlated with GWI and GCW(r=0.582, 0.433, P < 0.05), but had no correlation with GWW and GWE(r=0.168, 0.299, P > 0.05).
      Conclusion  PSL is valuable in evaluating early cardiotoxicity after chemotherapy in breast cancer patients.

     

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