目的：应用三维斑点追踪成像(3D-STI)技术分析化疗对肺癌患者左室心肌收缩功能的影响。方法追踪观察54例拟行化疗的肺癌患者,分别采集化疗前、化疗3个周期、化疗6个周期三个时点的常规超声心动图数值和3D-STI应变参数,应用后者获得左心室整体面积应变( GAS)、整体纵向应变( GLS )、整体圆周应变( GCS )、整体径向应变( GRS)等参数,对上述参数进行比较分析,并应用受试者工作特征( ROC)曲线评价三维应变参数对诊断心脏毒性的应用价值。结果化疗6个周期组GAS、GLS、GCS明显低于化疗前组、化疗3个周期组(P <0．05),化疗3个周期组GAS、GLS明显低于化疗前组( P<0．05)；ROC曲线显示,左心室GAS的曲线下面积为0．947,以-30．2%为截断值时,判断化疗药物对左室功能损害的特异性为91．2%,敏感性为85．0%。结论 GAS检出化疗药物对肺癌患者心脏毒性的特异性、敏感性较高,3D-STI可早期检测化疗药物对肺癌患者的心脏毒性损害,具有较高的临床参考价值。%Objective To investigate the value of three-dimensional speckle tracking imaging(3D-STI) technology in evaluating the influence of chemotherapeutic agents on left ventricular myocardial systolic function in patients with lung cancer. Methods A total of 54 patients with lung cancer were recruited. Conventional echocardiography and 3D-STI derived parameters were measured in the group before chemotherapy, at 3 chemotherapeutic cycles and at 6 chemotherapeutic cycles. Their left ventricular global area strain(GAS), global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS) were obtained by 3D-STI. The above parameters were compared and analyzed. The receiver operating characteristics( ROC) curve was constructed to determine opti-mal sensitivity and specificity for the prediction of future cardiotoxicity. Results GAS, GLS and GCS were signifi-cantly lower in the group at 6 chemotherapeutic cycles than before chemotherapy and at 3 chemotherapeutic cycles ( P<0. 05 );GAS and GLS were lower in the group at 3 chemotherapeutic cycles than before chemotherapy with statistical significance(P<0. 05). The area under ROC curve of GAS was 0. 947, and its optimal cut-off value was-30. 2%, with a specificity of 91. 2% and sensitivity of 85. 0%. Conclusion GAS has a high specificity and sen-sitivity in detection of left ventricular myocardial dysfunction. 3D-STI can early detect the cardiotoxicity of chemo-therapeutic agents in lung cancer patients.
展开▼
