| 摘要: |
| 目的 应用自动瓣环运动定量（aTMAD）技术评价蒽环类药物对乳腺癌患者右室收缩功能的影响。方法 收集50例行表柔比星为主化疗方案治疗的乳腺癌患者，分别于化疗前和化疗第2、4周期后行二维超声心动图检查获取左室射血分数（LVEF）、右室面积变化率（FAC）及三尖瓣环收缩期位移（TAPSE）；二维斑点追踪技术（2D-STI）获取右室整体纵向峰值应变（RVGLS）；aTMAD测量三尖瓣环位移（TAD）获取三尖瓣环右室游离壁收缩期峰值位移（T1）、三尖瓣环间隔收缩期峰值位移（T2）、三尖瓣环连线中点峰值位移（Tm）及Tm与右室舒张末期最大纵径比值（Tm%）。比较各化疗周期上述参数的差异，分析TAD参数与FAC、TAPSE、RVGLS的相关性,比较各超声参数与蒽环类药物的剂量相关性，通过绘制受试者工作特征曲线寻找各参数的最佳诊断临界值，并对RVGLS和Tm%进行重复性检验。结果 ①与化疗前比较，化疗第4周期后LVEF、FAC及TAPSE均降低，化疗第2、4周期后RVGLS、T1、T2、Tm及Tm%均降低，差异均有统计学意义（均P＜0.05）。②各化疗周期Tm%与RVGLS均呈强相关（r=0.848、0.748、0.795，均P＜0.05），与RVFAC均呈弱相关（r=0.544、0.447、0.347，均P＜0.05），与TAPSE均呈弱相关（r=0.436、0.291、0.305，均P＜0.05）；RVGLS、T1、T2、Tm及Tm%与药物剂量均呈负相关（r=-0.785、-0.852、-0.730、-0.765、-0.862，均P＜0.05），且相关程度高于常规二维超声。③ROC曲线分析显示：RVGLS的截点值18.35%，灵敏度90.7%，特异度85.7%，曲线下面积0.94；Tm%的截点值15.15，灵敏度95.3%，特异度85.7%，曲线下面积0.93。④重复性检验分析显示：RVGLS和Tm%观察者内的组内相关系数分别为0.891、0.937，观察者间的组内相关系数分别0.850、0.890。结论 应用aTMAD技术测量TAD可以评价乳腺癌化疗患者右室收缩功能障碍，且Tm%较RVGLS测量更简便易行，且重复性好，具有重要的临床应用价值。 |
| 关键词: 超声心动描记术 心室功能，右 三尖瓣环位移 蒽环类 乳腺癌 |
| DOI： |
| 投稿时间：2020-01-02修订日期：2020-11-17 |
| 基金项目:山西省留学回国人员科技活动择优资助项目（2060503-41） |
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| Evaluating the effect of anthracycline on right ventricular systolic function in patients with breast cancer by automatic tracking of motion annular displacement |
| zhanglifang,guotai,liugaizhen,lufang |
| () |
| Abstract: |
| Objective To evaluate the effect of anthracycline on right ventricular function in patients with breast cancer by automatic tracking of motion annular displacement. Methods 50 patients with breast cancer using the anthracycline-based chemotherapy were followed up，and routine echocardiography，Two-dimensional speckle tracking technology andautomatic tracking of motion annular displacement were performed before chemotherapy and after 2nd and 4th cycle of chemotherapy.The left ventricular ejection fraction（LVEF），right ventricular fractional area change（FAC），and tricuspid annular plane systolic excursion（TAPSE） were obtained by routine echocardiography. The global longitudinal peak strain of right ventricle （RVGLS） was obtained by two-dimensional speckle tracking technology.The TAD parameters including TAD at the right ventricular free wall （T1），TAD at the interventricular septum （T2），TAD at the midpoint of tricuspid annulus （Tm） and the right ventricular longitudinal shortening （Tm%） were obtained using automatic tracking of motion annular displacement. The differences of the above parameters for each chemotherapy cycle were compared, and the correlation between the TAD parameters and the FAC、TAPSE、RVGLS was analyzed, and the correlation between each parameter of ultrasonic and drug cumulative dose was compared, and we obtained the best value ultrasonic diagnosis parameters by ROC, and further the repeatability of RVGLS and Tm% was tested. Results ①LVEF，FAC and TAPSE were decreased in the 4th cycle compared with the before chemotherapy（all P＜0.05）.RVGLS，T1，T2，Tm and Tm% were lower in the 2nd and 4th cycle compared with the before chemotherapy（all P＜0.05）.②There was a strong correlation between Tm% and RVGLS（r=0.848，0.748，0.795，all P＜0.05），and a weak correlation with RVFAC(r=0.544、0.447、0.347, all P＜0.05) and a weak correlation with TAPSE（r=0.436、0.291、0.305，all P＜0.05). RVGLS，T1，T2，Tm and Tm% were negatively correlated with drug doses（r=0.785，0.852,0.730，0.765，0.862，all P＜0.05), and the correlation was higher than that routine echocardiography.③ROC curve analysis showed that the diagnostic cut off valu of RVGLS is 18.35, the diagnostic sensitivity was 90.7%，specificity was 85.7%, and an area under the curve of 0.94. The diagnostic cut off valu of Tm% is 15.15, the diagnostic sensitivity was 95.3%，specificity was 85.7%, and an area under the curve of 0.93.④Repeatability test showed that the intra-observer ICC values of the mean values of RVGLS and Tm% were 0.891 and 0.937 respectively，and the inter-observer ICC values were 0.850 and 0.890 respectively.Conclusion The technology of aTMAD can be used to identify right ventricular global systolic dysfunction in patients with breast cancer receiving chemotherapy，and Tm% is more convenient than RVGLS，which is repeatable and worthy of clinical promotion. |
| Key words: Echocardiography Ventricular function Right Tricuspid annular displacement Anthracycline Breast cancer |
