超声二维应变评价表阿霉素复合药物对左心室扭转运动影响的研究

摘要

Objective To evaluate left ventricular twist of Epirubicin induced cardiotoxicity using two dimensional strain imaging(2DSI). Methods 130 breast cancer patients were divided into three groups:Thirty-seven patients after surging without chemotherapy in group A as the control group. Fourty-five patients in group B were given Epirubi-cin(Epi)of 180-240 mg/m2. Fourty-eight patients in group C were given Epirubicin of ≥360 mg/m2. High frame rate two-dimensional images were recorded from the left ventricular short-axis views at the levels of mitral annulus and apex,and from the apical four-chamber view,two-chamber view and long-axis of the left ventricle. The peak systolic rotations were measured in the left ventricular short-axis views using two-dimensional strain software and the peak systolic torsions were calculated. And the conventional echcardiographic parameters were also obtainted. Results The conventional echcardiographic parameters had no significantly difference among three groups(P>0. 05). The peak systolic torsion in groups B were increased,but no significantly difference when compared with the groups A and C(P> 0. 05). The peak systolic torsion in group C were considerably increased, had significantly difference when compared with the groups A and B(P<0. 05). Conclusions The left ventricular systolic torsion has already changed in patients treated with Eprirubincin-induced cardiotoxity when the left ventricular systolic function maintained normal. Two dimensional strain imaging may be valuable to assess the left ventricular twist and early index of left ventricular dysfunction in patients treated with Eprirubincin-induced cardiotoxity.%目的 探讨二维应变技术评价乳腺癌术后患者表阿霉素复合药物对左心室扭转运动影响价值.方法 130例乳腺癌患者分为3组:A组为对照组,37例,未给予化疗.B组45例,采用以表阿霉素(Epi)为主的化疗方案(环磷酰胺+Epi+5-氟尿嘧啶),Epi累积剂量180～240 mg/m2;C组48例,同样化疗方案Epi≥360mg/m2.获取左室短轴二尖瓣环水平、心尖水平二维图像及心尖位四腔图、二腔图、左心长轴的二维图像,对3组患者心脏进行常规超声参数测定；左室短轴二尖瓣水平、心尖水平各心肌节段收缩期旋转角度峰值,计算左室短轴心肌收缩期扭转角度峰值.结果 (1)3组间各常规参数无显著性差异(P＞0.05)；(2)3组左室短轴心肌收缩期扭转角度峰值比较,B组扭转角度峰值增大,但与A组比较无显著性差异(P＞0.05)；C组扭转角度峰值明显增大,与A组、B组间比较均有显著性差异(P＜0.05).结论 较大剂量Epi复合药物治疗乳腺癌术后患者在常规测量左室收缩功能正常时,左室短轴扭转角度已出现改变,利用超声二维应变成像可准确检测Epi复合药物患者左室心肌扭转角度,能较早地评估患者的左心室收缩功能.