目的:探讨应变和应变率成像技术在评价表阿霉素致乳腺癌患者左心功能影响中的优势.方法:选择经病理确诊的女性乳腺癌患者78例.均采用FEC方案化疗.采用自身对照研究对乳腺癌患者6个化疗周期进行观察,分别于化疗前1天及每周期化疗后第5天行心电图、心肌酶学、常规超声心动图及应变率成像检测.SPSS13.0统计软件进行统计分析.结果:随表阿霉素累积量增加,于第4、5周期时心电图异常率增加,第6周期时,心电图异常率明显增加,与化疗前比较,差异有统计学意义(P＜0.05);第6周期时出现心肌酶增高(P＜ 0.05);第6周期时左室射血分数(LVEF)及E/A减低(P＜0.05);应变率成像结果显示:随表阿霉素累积量的增加,于第4周期时舒张早期峰值应变率(SRe)、房缩期峰值应变率(SRa)减低(P＜ 0.05),第5周期时SRe、SRa明显减低(P＜ 0.01),第6周期时,出现下壁及前壁的SRs减低(P＜0.05),后间隔、侧壁、前间隔及后壁的SRs明显减低(P＜0.01).结论:乳腺癌患者化疗过程中,随表阿霉素累计量的增加,心电图和应变率成像较早出现异常,而心肌酶和常规超声心动图指标则较晚出现异常.应变率成像能够早期较精确的反映表阿霉素致乳腺癌患者左心功能的影响.%Objective:To discuss the advantage of strain and strain rate imaging for the left ventricular function of breast cancer patients with Epirubicin. Methods: To select 78 cases of female breast cancer patients pathologically diagnosed treated by FEC chemotherapy, and detect ECG, myocardial enzymes, conventional echocardiography and strain rate imaging. Results: The rate of abnormal ECG occur at T4 and T5( P ＜ 0.05 ). The rate of abnormal ECG at T6 was significantly increased( P ＜ 0.01 ). Enzyme changed with the epirubicin cumulative increased at T6( P ＜0.05 ). Left ventricular ejection fraction ( LVEF ) and E/A were decreased at T6( P ＜ 0.05 ). The SRe and Sra decreased at T4( P ＜ 0.05 ), and which decreased significantly at To( P ＜ 0.01 ). At T6 the SRs of infferior and anterior decreased ( P ＜ 0.05 ), but after the interval, the wall, anterior septum and posterior wall decreased significantly ( P ＜ 0.01 ). Conclusion: The abnormal ECG and the strain rate imaging occurred earlier than the changes of enzymes and conventional echocardiography. Strain rate imaging can early reflect the influence of left ventricular function of the breast cancer patients with Epirubicin accuracy.
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