超声心动图评价赫塞汀对乳腺癌患者心脏毒性

摘要

目的:探讨利用组织多普勒和常规超声心动图评估乳腺癌患者赫塞汀心脏毒性.方法:80例接受赫塞汀化疗的女性乳腺癌患者,赫塞汀总累积量14mg/kg,开始化疗前及每个疗程结束后进行心脏超声检查并测量相关参数.健康对照组40例.常规超声心动图指标包括左室舒张末内径(left ventricular end diastolic diameter,LVEDD),左室收缩末内径(left ventricular end systolic diameter,LVESD),左室射血分数(left ventricular ejection fraction,LVEF),二尖瓣口血流速度(早期速度E、晚期速度A及两者比值E/A)组织多普勒超声心动图指标有二尖瓣环左室侧壁处组织多普勒峰值速度(收缩峰速S',舒张早期峰速E',舒张晚期峰速A及E'/A').结果:与治疗前相比,常规超声心动图指标LVEDD、LVESD较治疗前无明显差别(P＞0.05);LVEF在累积量达到12mg/kg,出现显著差别[(58.07 ±6.60)％vs(68.65 ±6.70)％,P＜0.05],舒张功能指标E/A在累积量达到14mg/kg出现明显差别[(0.98 ±0.14) vs(1.19 ±0.13),P＜0.05].组织多普勒指标:S在累积量达到10mg/kg出现明显差别[(8.70±1.97) cm/s vs(10.55±2.31) cm/s,P＜0.05],E'/A在累积量达到8mg/kg即出现明显差别[(0.87±0.28) vs(1.12 ±0.30),P＜0.05].与健康对照组相比,80例接受赫塞汀化疗的乳腺癌患者第一次治疗前各指标无明显差别(P＞0.05).结论:组织多普勒超声心动图较常规超声心动图能更敏感地监测乳腺癌患者赫塞汀化疗的心脏改变.%Objective:To discuss the assessment in cardiotoxicity caused by Herceptin in treatment of breast cancer with Doppler and conventional echocardiography.Methods:All 80 female breast cancer patients treated with Herceptin chemotherapy were tested,the total accumulated volume of Herceptin was 14mg/kg.The echocardiography was performed twice,one was performed before chemotherapy,and the other was performed after chemotherapy.The relevant parameters were measured and compared with those of 40 selected healthy women.Conventional echocardiography parameters included left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),early and late wave of mitral valve flow(E/A).Tissue Doppler echocardiography parameters included systolic wave(S'),early and late wave of pulse tissue Doppler in lateral wall of mitral annulus.Results:To compare with baseline before chemotherapy,there was no significant change (P ＞ 0.05) in conventional echocardiography systolic parameters,LVEDD and LVESD.LVEF changed significantly at total dose of 12mg/kg[(58.07 + 6.60)％ vs (68.65 ± 6.70)％,P ＜ 0.05].Conventional echocardiography diastolic parameter E/A changed significantly at total dose of 14mg/kg[(0.98 ± 0.14) vs (1.19 ± 0.13),P ＜ 0.05].While tissue Doppler echocardiograph systolic parameter S' changed significantly at total of dose 10 mg/kg [(8.12 ± 1.97)vs(10.55± 2.31),P ＜ 0.05].Tissue Doppler echocardiography diastolic parameter E'/A'changed significantly at total of dose 8 mg/kg[(0.87 ± 0.28) vs (1.12 ± 0.30),P ＜ 0.05].To compare with those of the healthy women,there was no significant change in every parameters of baseline tested before first chemotherapy from eighty breast cancer patients (P＞ 0.05).Conclusion:To compare with conventional echocardiography,TDE is more sensitive to cardiac toxicity caused by Herceptin in treatment of breast cancer.