应变及扭转技术评价多柔比星脂质体治疗乳腺癌继发心肌毒性的初步观察
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摘要
目的:应用二维斑点追踪技术(2D-STI)应变和扭转技术检测乳腺癌(breast carcinoma患者使用多柔比星脂质体(DOX)化疗后的左心室心肌生物力学参数改变,探讨2D-STI评价和监测DOX化疗所致心脏功能损害的应用价值。方法:选择50例确诊初发乳腺癌并手术治疗住院患者及30例健康受试者。应用2D-STI检测正常对照组及DOX方案化疗,化疗前及化疗1～5疗程患者心脏整体纵向应变(GLS)、左室扭转角度(LVtw)等,计算GLS×LVtw值,分析比较乳腺术后化疗前后各心脏参数差异。结果:对照组及乳腺癌患者化疗前参数比较,差异均无统计学意义(P>0.05),化疗后GLS的绝对值较化疗前和对照组均下降,化疗后GLS×LVtw绝对值明显低于化疗前及对照组,差异均有统计学意义(P<0.01),化疗5个周期后超声指标符合心肌毒性诊断标准4例患者GLS、GLS×LVtw绝对值明显下降,以△GLS值-6.31%为截断点预测心肌毒性灵敏度、特异度分别为78%、89%;以△GLS×LVtw值-16.12%×°为截断点预测心肌毒性灵敏度、特异度分别为91%、60%。结论:传统超声不能检测DOX化疗所致早期心功能损害,2D-STI可以检测心肌应变和扭转技术特性早期改变,在早期检测化疗药物所致心功能损害方面敏感。
Objective:To assess the changes of left ventricle myocardial strain and twist by using 2 D-STI(two dimension speckle tracking imaging),to study the value of strain and twist in monitoring early DOXinduced cardiotoxicity with aim of providing a more proper way in non-invasively predicting the early DOX-induced cardiotoxicity.Method:50 patients who were firstly diagnosed of breast carcinoma and 300 healthy volunteers without organic cardiac diseases were selected.The global longitudinal strain(GLS)and left ventricular torsion angle(LVtw)were measured by 2 D-STI in normal control group and patients before and after chemotherapy with DOX regimen.The GLS × LVtw values were calculated and compared before and after chemotherapy with DOX regimen.Result:There was no significant difference in parameters between the control group and breast cancer patients before chemotherapy(P>0.05).The absolute value of GLS after chemotherapy was lower than that before chemotherapy and the control group.The results of GLS×LVtw after chemotherapy were significantly lower than those before chemotherapy and the control group(P<0.01).Ultrasound parameters of 4 patients who met the diagnostic criteria of myocardial toxicity after 5 cycles of chemotherapy were significantly lower than those before chemotherapy and the control group(P<0.01).The sensitivity and specificity of myocardial toxicity were 78% and 89% with △GLS value of-6.31% as the cut-off point,the sensitivity and specificity of myocardial toxicity were 91% and 60% with △GLS×LVtw value of-16.12%×° as the cut-off point.Conclusion:The traditional ultrasound can not detect early cardiac dysfunction caused by chemotherapy with DOX,2 D-STI can detect early changes of left myocardium strain and twist properties with higher sensitive,it may become one of effective indicators in predicting secondary early myocardial toxicity after DOX chemotherapy.
Objective:To assess the changes of left ventricle myocardial strain and twist by using 2 D-STI(two dimension speckle tracking imaging),to study the value of strain and twist in monitoring early DOXinduced cardiotoxicity with aim of providing a more proper way in non-invasively predicting the early DOX-induced cardiotoxicity.Method:50 patients who were firstly diagnosed of breast carcinoma and 300 healthy volunteers without organic cardiac diseases were selected.The global longitudinal strain(GLS)and left ventricular torsion angle(LVtw)were measured by 2 D-STI in normal control group and patients before and after chemotherapy with DOX regimen.The GLS × LVtw values were calculated and compared before and after chemotherapy with DOX regimen.Result:There was no significant difference in parameters between the control group and breast cancer patients before chemotherapy(P>0.05).The absolute value of GLS after chemotherapy was lower than that before chemotherapy and the control group.The results of GLS×LVtw after chemotherapy were significantly lower than those before chemotherapy and the control group(P<0.01).Ultrasound parameters of 4 patients who met the diagnostic criteria of myocardial toxicity after 5 cycles of chemotherapy were significantly lower than those before chemotherapy and the control group(P<0.01).The sensitivity and specificity of myocardial toxicity were 78% and 89% with △GLS value of-6.31% as the cut-off point,the sensitivity and specificity of myocardial toxicity were 91% and 60% with △GLS×LVtw value of-16.12%×° as the cut-off point.Conclusion:The traditional ultrasound can not detect early cardiac dysfunction caused by chemotherapy with DOX,2 D-STI can detect early changes of left myocardium strain and twist properties with higher sensitive,it may become one of effective indicators in predicting secondary early myocardial toxicity after DOX chemotherapy.
引文
[1]马军,秦叔逵,沈志祥.蒽环类药物心脏毒性防治指南(2013年版)[J].临床肿瘤学杂志,2013,18(10):925-934.
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[13]张颖,龚兆萍,嵇平.应变率成像和肌钙蛋白Ⅰ联合监测蒽环类药物心脏毒性的研究[J].临床超声医学杂志,2013,15(7):452-455.
[14]骆楚君,钟黛云,张建萍.多柔比量和表柔比星治疗转移性乳腺癌的系统评价[J].中国药学杂志,2016(4):321-325.
[15]洪少杰,林树洪,于瑞芳.超声二维斑点追踪技术监测蒽环类药物治疗恶性淋巴瘤后心脏功能变化[J].肿瘤学杂志,2017,23(1):49-53.
[16]宋飞艳,程蕾蕾.超声心动图监测淋巴瘤患者蒽环类药物化疗后右心室亚临床功能减退的应用[J].复旦学报(医学版),2016,43(2):231-235.
[17]Mornos C,Petrescu L.Early detection of DOXracycline-mediated cardiotoxicity:the value of considering both global longitudinal left ventricular strain and twist[J].Canadian Journal of Physiology and Pharmacology,2013,91(8):601-607.
[18]Vonminckwitz G,Schneeweiss A,Loibl S,et al.Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer(Gepar Sixto;GBG 66):A randomised phase 2 trial[J].The lancet oncology,2014,7(7):747-756.
[19]Baselga J,Manikhas A,Cortes J,et al.PhaseⅢtrial of nonpegylated liposomal doxorubicin in combination with trastuzumab and paclitaxel in HER2-positive metastatic breast cancer[J].Annals of Oncology:Official Journal of the European Society for Medical Oncology,2014,3(3):592-598.
[20]Zagar T,Vujaskovic Z,Formenti S,et al.Two phase I doseescalation/pharmacokinetics studies of low temperature liposomal doxorubicin(LTLD)and mild local hyperthermia in heavily pretreated patients with local regionally recurrent breast cancer[J].North American Hyperthermia Group,2014,5(5):285-294.
[2]姚梦云.二维超声斑点追踪成像技术对乳腺癌患者表柔比星化疗前、后左室收缩功能及扭转运动的研究[D].武汉:华中科技大学,2013.
[3]Sawaya H,Sebag I A,Plana J C,et al.Early detection and prediction of cardiotoxicity in chemotherapy-treated patients[J].The American Journal of Cardiology,2011,107(9):1375-1380.
[4]Motoki H,Koyama J,Nakazawa H,et al.Torsion analysis in the early detection of anthracycline-mediated cardiomyopathy[J].European Heart Journal Cardiovascular Imaging,2012,13(1):95-103.
[5]Khakoo A Y,Liu P P,Force T,et al.Cardiotoxicity due to cancer therapy[J].Texas Heart Institute Journal,2011,38(3):253-256.
[6]涂俊,杨娟,刘景丽,等.不同制剂紫杉醇联合表柔比星治疗晚期乳腺癌的临床观察[J].实用肿瘤杂志,2017,32(2):168-172.
[7]Rosiol L,Oriol A,Teruel A,et al.Superiority of bortezomib,thalidomide,and dexamethasone(VTD)as induction pretransplantation therapy in multiple myeloma:A randomized phase 3 PETHEMA/GEM study[J].Blood:The Journal of the American Society of Hematology,2012,8(8):1589-1596.
[8]宋飞艳,程蕾蕾,史静.二维斑点追踪显像联合实时三维超声心动图监测淋巴瘤患者蒽环类药物化疗后左心室亚临床功能的改变[J].中华超声影像学杂志,2016,25(3):104-106.
[9]Rochette L,Guenancia C,Gudjoncik A,et al.Anthracyclines/trastuzumab:new aspects of cardiotoxicity and molecular mechanisms[J].Trends Pharmacol Sci,2015,6(6):326-348.
[10]薛继平,苏莉莉,康春松.斑点追踪技术评价蒽环类药物对乳腺癌患者左心室跨壁力学的影响[J].中华超声影像学杂志,2015,5(12):1033-1038.
[11]韩勇,董云,刘怡.左心室整体心肌应变分析乳腺癌术后蒽环类化疗药物心脏毒性[J].中华超声影像学杂志,2014,23(2):104-108.
[12]张杰,姜志荣,王小凡,等.二维斑点追踪成像技术在评价蒽环类药物心脏毒性中的临床价值[J].临床超声医学杂志,2014,16(4):239-242.
[13]张颖,龚兆萍,嵇平.应变率成像和肌钙蛋白Ⅰ联合监测蒽环类药物心脏毒性的研究[J].临床超声医学杂志,2013,15(7):452-455.
[14]骆楚君,钟黛云,张建萍.多柔比量和表柔比星治疗转移性乳腺癌的系统评价[J].中国药学杂志,2016(4):321-325.
[15]洪少杰,林树洪,于瑞芳.超声二维斑点追踪技术监测蒽环类药物治疗恶性淋巴瘤后心脏功能变化[J].肿瘤学杂志,2017,23(1):49-53.
[16]宋飞艳,程蕾蕾.超声心动图监测淋巴瘤患者蒽环类药物化疗后右心室亚临床功能减退的应用[J].复旦学报(医学版),2016,43(2):231-235.
[17]Mornos C,Petrescu L.Early detection of DOXracycline-mediated cardiotoxicity:the value of considering both global longitudinal left ventricular strain and twist[J].Canadian Journal of Physiology and Pharmacology,2013,91(8):601-607.
[18]Vonminckwitz G,Schneeweiss A,Loibl S,et al.Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer(Gepar Sixto;GBG 66):A randomised phase 2 trial[J].The lancet oncology,2014,7(7):747-756.
[19]Baselga J,Manikhas A,Cortes J,et al.PhaseⅢtrial of nonpegylated liposomal doxorubicin in combination with trastuzumab and paclitaxel in HER2-positive metastatic breast cancer[J].Annals of Oncology:Official Journal of the European Society for Medical Oncology,2014,3(3):592-598.
[20]Zagar T,Vujaskovic Z,Formenti S,et al.Two phase I doseescalation/pharmacokinetics studies of low temperature liposomal doxorubicin(LTLD)and mild local hyperthermia in heavily pretreated patients with local regionally recurrent breast cancer[J].North American Hyperthermia Group,2014,5(5):285-294.