应变率显像技术对化疗药物所致心脏毒性的评价

摘要

目的:探讨应变率显像技术在评价表阿霉素致乳腺癌患者左室心肌局部收缩及舒张功能影响中的优势.方法:选择经医院病理确诊的90例女性乳腺癌患者,均采用5-氟尿嘧啶-表阿霉素/表柔吡星-环磷酰胺(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 d及每周期化疗后第5 d行心肌酶学、常规超声心动图及应变率成像检测.结果:随表阿霉素累积量增加,应变率成像结果显示,与化疗前相比基底部舒张早期峰值应变率(SRe)、舒张晚期峰值应变率(SRa)在第5周期时发生明显降低,差异有统计学意义(SRe:F=1.923,P<0.05;SRa:F=2.245,P<0.05);第6周期收缩期峰值应变率(SRs)明显降低,差异有统计学意义(基底部:t=2.334,P<0.05;中部:t=2.401,P<0.05).常规超声心动图结果显示,第6周期时,受试患者的左室舒张早期充盈峰/舒张晚期充盈峰(E/A)较化疗前减低,差异有统计学意义(t=2.953,P<0.05);且谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)、肌酸磷酸激酶同功酶(CK-MB)以及α-羟丁酸脱氢酶(HBDH)在第6周期时出现升高,与化疗前相比差异有统计学意义(t=1.991,t=1.231,t=2.301,t=1.844,t=1.599;P<0.05).结论: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 explore the advantages of strain rate imaging in evaluating the effect of epirubicin for left ventricular myocardial regional systolic and diastolic function of patients with breast carcinoma. Methods: 90 patients with breast carcinoma received FEC chemotherapy (5- Fu, epirubicin and cyclophosphamide) were enrolled in the self- control study. There were 6 chemotherapy periods of them were observed, and the detection of myocardial enzyme, routine echocardiography and strain rate imaging for patients were implemented before one day of chemotherapy and after fifth day of chemotherapy, respectively. Results: The results of strain rate imaging revealed, with the increasing of cumulant of epirubicin, the SRe and SRa of basilar part post-chemotherapy were obviously decreased than that pre-chemotherapy at fifth period, and the differences between pre and post chemotherapy were significant (SRe: F=1.923, P<0.05; SRa: F=2.245, P<0.05). At sixth period, the SRs was obviously decreased, and the difference between them was significant ( basilar part: t=2.334, P<0.05, middle part: t=2.401, P<0.05). The results of routine echocardiography revealed that the E/A of patients post chemotherapy was significant lower than that of patients pre chemotherapy (t=2.953, P<0.05) in 6th period. On the other hand, the AST, LDH, CK, CK-MB and HBDH of post chemotherapy were significant higher than that of pre-chemotherapy (t=1.9911, t=1.231, t=2.301, t=1.844, t=1.599, P<0.05). Conclusions: The strain rate imaging can relatively precisely reflect the effect of epirubicin for left ventricular function of patient with breast carcinoma in early stage.