| 摘要: |
| 目的 应用无创左室压力-应变环（PSL）获取接受蒽环类药物治疗的乳腺癌患者左室心肌做功（MV）参数，评价蒽环类化疗药物对左室功能的早中期影响。方法 选取乳腺癌术后接受蒽环类药物化疗患者30例（乳腺癌组）和正常健康志愿者30例（对照组），分别于化疗前1 d及下一周期化疗前1 d（T0、T1、T2、T3、T4、T5）行超声心动图检查。脉冲组织多普勒（PW-TDI）（请补中文全称）获取二尖瓣环六个位点收缩期峰值运动速度（S’）；斑点追踪技术（STI）及PSL获取左室整体纵向应变（GLS）、18节段纵向应变达峰时间标准差（Tls-SD）及最大差值（Tls-dif）、整体做功指数（GWI）、整体有用功（GCW）、整体无用功（GWW）及整体做功效率（GWE）等参数。比较上述参数的差异。结果 与对照组比较，乳腺癌组T0期收缩压、舒张压、左室射血分数（LVEF）、Tei指数、二尖瓣环TDI参数、应变参数及心肌做功参数均无统计学差异。与T0期比较，乳腺癌组T4、T5期S’-PostSept、S’-Lat、S’-Ant均显著减低（均P＜0.05）；T1~T5期余常规参数均无明显变化。与T0期比较，乳腺癌组T1~T3期GLS无明显变化，T4、T5期GLS均显著减低，且随着化疗周期进展呈递减趋势（均P＜0.05）；T4、T5期Tls-SD、Tls-dif均显著增大（P＜0.05）。与T0期比较，乳腺癌组T1~T3期GWI、GCW、GWW及GWE均无明显变化；T4、T5期GWI、GCW及GWE均显著减低，且随着化疗周期进展呈递减趋势（均P＜0.05）；T4、T5期GWW显著增加，且随着化疗周期进展呈递增趋势（均P＜0.05）。结论 接受蒽环类药物治疗的乳腺癌患者在化疗早中期，尽管尚未达到常规超声心脏毒性诊断标准，但其左室收缩功能已受损；PSL可从心肌做功角度评估左室收缩功能，为早期评估乳腺癌化疗相关心功能异常提供新的评价指标。 |
| 关键词: 超声心动描记术；左室压力-应变环 心肌做功 应变 乳腺癌 化疗 |
| DOI： |
| 投稿时间：2020-08-16修订日期：2021-03-05 |
| 基金项目: |
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| Quantitative evaluation of left ventricular myocardial work by pressure-strain loop in breast cancer patients undergoing anthracycline-based chemotherapy |
| Wan Mengting,Chen Jinling,Zhao Zhiyu,Mei dane,Feng Chuangli,Yu Caigui,Chen Chuang |
| (Renmin Hospital of Wuhan University) |
| Abstract: |
| Objective The study aimed to obtain strain and myocardial work（MV） parameters by non-invasive left ventricular（LV） pressure-strain loop（PSL） and to evaluate effects of anthracycline-based chemotherapy on LV myocardial function at early and middle stage in patients with breast cancer.Methods Thirty breast cancer patients treated by anthracycline-based chemotherapy and 30 controls were recruited and echocardiography were performed before and after1，2，3，4，5 chemotherapeutic cycle （T0，T1，T2 T3，T4，T5）.TDI parameters included S’ of six points in mitral annulus.Speckle tracking imaging（STI） obtain LV global longitudinal strain（GLS），standard deviations and maximal differences of time to peak regional LS（Tls-SD，Tls-dif） in all 18 segments.MW parameters from LV-PSL included global work index（GWI），global constructive work（GCW），global waste work （GWW） and global work efficiency（GWE）.Compare the parameters mentioned above. Results Compared with controls，blood pressure，LVEF，Tei index，TDI parameters，myocardial strain and MW parameters in the chemotherapeutic groups at T0 showed no significant differences（p＞0.05）. Compared with T0，S’-PostSept，S’-Lat，S’-Ant decreased significantly at T4 and T5（P<0.05），while there was no significant difference in the rest of traditional parameters. Compared with T0，GLS reduced significantly at T4 and T5，showing a gradually decreasing trend as the chemotherapy cycle progressed，while Tls-SD and Tls-dif increased significantly at T4 and T5（p＜0.05）. Compared with T0，GWI, GCW and GWE reduced significantly at T4 and T5，showing a gradual declining tendency as the chemotherapy cycle progressed，while GWW presented gradual inclining tendency（p＜0.05）.Conclusion Though breast cancer patients treated with anthracycline-based chemotherapy did not meet clinical diagnostic criteria for cardiotoxicity in the early and middle stages，they had showed LV dysfunction signs.MW parameters obtained by PSL could assess myocardial work quantitatively and detect myocardial dysfunction sensitively in these patients，which provide a new ultrasound technology for the evaluation of chemotherapy-related cardiac function impairment. |
| Key words: echocardiography presure-strain loop myocardial work strain breast cancer chemotherapy |
