超声三维斑点追踪技术评估蒽环类药物心脏毒性的早期识别
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摘要
目的:乳腺癌病人在接受蒽环类药物化疗药物后采用超声三维斑点追踪技术评估早期左心室功能改变,并探讨左室整体三维应变参数对检测化疗所致心脏毒性的价值。方法:收集我院2016-03～2018-03期间接受外科手术治疗后的女性乳腺癌病人30例,均接受6周期的TAC联合化疗方案。分别检测病人接受3 DST后的化疗前基础状态、化疗3周期、化疗6周期后的左室壁整体收缩期应变参数,包括整体纵向应变(GLS)、径向应变(GRS)、圆周应变(GCS)及面积应变(GAS),同时应用普通二维超声心动图采集左室舒张末容积(LVEDV),左室收缩末容积(LVESV),左室射血分数(LVEF),每搏输出量(SV),二尖瓣口血流频谱E/A值。结果:(1)与化疗前比较,化疗3周期及6周期后病人左室EDV、ESV、LVEF、SV及E/A差异均无统计学意义;(2)化疗3周期完成后左室GLS较化疗前减低,差异有统计学意义;6周期化疗完成后左室GLS、GAS均较化疗前显著减低,差异有统计学意义。结论:蒽环类药物的心脏毒性具有剂量累积性,且早期损害不易显现。三维超声斑点追踪技术可以早期发现蒽环类药物所引起的心肌损害,为临床及时调整方案并进行个体化治疗提供重要信息。
Objective:To assess the clinical significance of three-dimensional speckle tracking imaging(3 DST)in the evaluation of left ventricular myocardial function in breast cancer survivors with postoperative anthracycline-based chemotherapy.Methods:This thesis selects 30 breast cancer survivors with postoperative anthracycline-based chemotherapy over the period from March,2016 to March,2018.Three-dimensional speckle tracking echocardiography was performed before chemotherapy and after 3 and 6 anthracycline-based chemotherapeutic cycles,to assess the left ventricle's global three-dimensional strain.Conventional echocardiography was performed before chemotherapy and after 3 and 6 anthracycline-based chemotherapeutic cycles.Results:In comparison with baseline cases,no statistical difference in LVEDV,LVESV,LVEF,SV,E/A showed during and after the treatment.GLS and GAS were reduced after 3 cycles of treatment,and significantly decreased after 6 cycles of treatment.GCS and GRS were decreased but didn't show statistically significant after the last cycle of treatment.Conclusion:Cardiac toxicity caused by anthracycline is cumulative,and the early damage is hidden.Three-dimensional speckle-tracking echocardiography rovides a new sensitive and early method to evaluate early cardiac toxicity caused by anthracycline antineoplastic drugs compared with conventional echocardiography.
Objective:To assess the clinical significance of three-dimensional speckle tracking imaging(3 DST)in the evaluation of left ventricular myocardial function in breast cancer survivors with postoperative anthracycline-based chemotherapy.Methods:This thesis selects 30 breast cancer survivors with postoperative anthracycline-based chemotherapy over the period from March,2016 to March,2018.Three-dimensional speckle tracking echocardiography was performed before chemotherapy and after 3 and 6 anthracycline-based chemotherapeutic cycles,to assess the left ventricle's global three-dimensional strain.Conventional echocardiography was performed before chemotherapy and after 3 and 6 anthracycline-based chemotherapeutic cycles.Results:In comparison with baseline cases,no statistical difference in LVEDV,LVESV,LVEF,SV,E/A showed during and after the treatment.GLS and GAS were reduced after 3 cycles of treatment,and significantly decreased after 6 cycles of treatment.GCS and GRS were decreased but didn't show statistically significant after the last cycle of treatment.Conclusion:Cardiac toxicity caused by anthracycline is cumulative,and the early damage is hidden.Three-dimensional speckle-tracking echocardiography rovides a new sensitive and early method to evaluate early cardiac toxicity caused by anthracycline antineoplastic drugs compared with conventional echocardiography.
引文
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[14]Miyoshi T,Hidekazu tanaka M.D.Ph.D,Akihiro kaneko M.D.Ph.D,et al.Left ventricular endocardial dysfunction in patients with preserved ejection fraction after receiving anthracycline[J].EchocardiograPhy,2014;31(7):848-857
[15]Boyd A,Stoodley P,Richards D,et al.Anthracyclines induce early changes in left ventricular systolic and diastolic function:A single centre study[J].Plos One,2017;12(4):e0175544
[16]胡燕华,刘森,祝子祎,等.实时三平面组织多普勒成像在心脏再同步化治疗中的应用[J].内蒙古医科大学学报,2012;34(6):480-485
[2]张保宁.早期乳腺癌保留乳房手术的回顾与展望[J].中华乳腺病杂志:电子版,2010;04(3):1-3
[3]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
[4]中国临床肿瘤学会(csco).防治葸环类抗肿瘤药物心脏毒性的中国专家共识(2011版)[J].临床肿瘤学杂志,2011;16(12):1122-1129
[5]Watanabe N,otsuka S,sasaki Y,et al.Cardiac tolerability of concurrent administration of trastuzumab and anthracycline-based regimen as adjuvant chemotherapy for breast cancer[J].Breast Care(Basel),2014;9(1):46-51
[6]Carver JR,szalda D,kyb.Asymptomatic cardiac toxicity in long-term cancer survivors:defining the population and recommendations for surveillance[J].Semin Oncol,2013;40(2):229-238
[7]Al-biltagi M,Abd RE TO,El-shanshory MR,et al.Strain echocardiography in early detection of doxorubicin-induced left ventricular dysfunction in children with acute lymphoblastic leukemia[J].Isrn Pediatrics,2012;2012:1-9
[8]Poterucha JT,Shelby K,Lindquist RK,et al.Changes in left ventricular longitudinal strain with anthracycline chemotherapy in adolescents precede subsequent decreased left ventricular ejection fraction[J].Journal of the American Society of EchocardiograPhy Official Publication of the American Society of EchocardiograPhy,2012;25(7):733-740
[9]Yu AF,Raikhelkar J,Zabor EC,et al.Two-dimensional speckle tracking echocardiography detects subclinical left ventricular systolic dysfunction among adult survivors of childhood,Adolescent,And young adult cancer[J].BioMed Research International,2016;2016:2314-6141
[10]Heloisa sawaya,Igal A.Sebag,Juan carlos plana,et al.Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines,Taxanes,And trastuzumab[J].Circulation Cardiovascular Imaging,2012;5(5):596-603
[11]Yagmur J,Sener S,Acikgoz N,et al.Subclinical left ventricular dysfunction in behcet′s disease assessed by two-dimensional speckle tracking echocardiography[J].Eur J Echocardiogr,2011;12(7):536-541
[12]Kleijn SA,Aly MF A,Terwee CB,et al.Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain[J].Journal of the American Society of EchocardiograPhy,2011;24(3):314-321
[13]Galderisi M,Esposito R,Schiano V,et al.Correlates of global area strain in native hypertensive patients:a three-dimensional speckle-tracking echocardiography study[J].Eur Heart J Cardiovasc Imaging,2012;13(9):730-738
[14]Miyoshi T,Hidekazu tanaka M.D.Ph.D,Akihiro kaneko M.D.Ph.D,et al.Left ventricular endocardial dysfunction in patients with preserved ejection fraction after receiving anthracycline[J].EchocardiograPhy,2014;31(7):848-857
[15]Boyd A,Stoodley P,Richards D,et al.Anthracyclines induce early changes in left ventricular systolic and diastolic function:A single centre study[J].Plos One,2017;12(4):e0175544
[16]胡燕华,刘森,祝子祎,等.实时三平面组织多普勒成像在心脏再同步化治疗中的应用[J].内蒙古医科大学学报,2012;34(6):480-485