斑点追踪技术评价化疗对癌症患者左心功能的影响

摘要

Objective To evaluate systolic and diastolic function of left ventricle (LV) by Two-dimensional speckle tracking echocardiography (2D-STI) in cancer patients receiving chemotherapy. Methods A total of 108 patients receiving chemotherapy were included in this study. Every patient were studied in four stages(before chemotherapy,after the first cycle of chemotherapy, middle cycle of chemotherapy and after the last cycle of chemotherapy) Scerum cTnT and cTnI levels were tested in every stage. The global longitudinal systolic strain(GSL) and strain rale (GSRs) of LV as well as early-diastolic strain rate (GSRe) and late-diastolic strain rate (GSRa) were measured by 2D-STI. Results Compared to the data before chemotherapy, GSRe and GSRa after the first cycle and middle cycle of chemotherapy had no significantly difference (P>0. 05). After the last stage of chemotherapy, the GSL and GSRs decreased significantly (P<0. 01). Compared to those before chemotherapy, the patients, GSRe and GSRa after the first cycle chemotherapy had no significantly difference (P>0. 05) , but compared to those of the middle and the last cycle of chemotherapy, GSRe and GSRa had significantly difference (P<0. 01). cTnT and cTnI of every stage of chemotherapy significangly increased and had a trend of gradually rising , the rate of abnormal electrocardiogram(ECG)also had a trend of gradually rising and had significantly difference (P<0. 01). Conclusions The LV systolic and diastolic dysfunction in patients receiving chemotherapy can be early detected by 2D-STI, which provide a relatively sensitive and accurate method for clinical evalution of LV function.%目的 探讨应用二维斑点追踪成像(2D-STI)技术评价化疗对癌症患者左室整体收缩及舒张功能的影响.方法 选取108例癌症患者,每例分为化疗前、首次化疗后、全疗程一半、全疗程结束4个阶段.每个阶段常规进行cTnT、cTnI及心电图检查,同时应用2D-STI获取心尖位左室长轴观、两腔观和四腔观各节段收缩期纵向峰值应变及应变率,并计算左室收缩期整体纵向应变值(GSL)及应变率(GSRs)、舒张早期及舒张晚期整体纵向应变率(GSRa、GSRe).结果 与化疗前相比较,首次化疗后、全疗程一半时患者GSL及GSRs无明显变化(P＞0.05),全疗程结束时上述参数下降,有统计学意义(P＜0.01)；首次化疗后患者GSRe及GSRa变化无统计学意义(P＞0.05)；全疗程一半、全疗程结束时患者GSRe及GSRa明显下降,有统计学意义(P＜0.01).化疗后各阶段的cTnT和cTnI均较化疗前升高,且有逐渐上升趋势,异常心电图检出率也呈逐渐上升的趋势且统计学有意义(P＜0.01).结论 2D-STI技术能早期检测化疗药物对癌症患者左室收缩及舒张功能的影响,为临床提供一种相对较敏感、准确的检测方法.