| 摘要: |
| 目的：利用列线图探究超声联合血清学指标早期预测乳腺癌术后化疗的心脏毒性。方法：选取于我院乳腺外科术后确诊为乳腺癌的女性患者，所有患者均在术后2周接受化疗，根据化疗1年后是否发生左心室射血分数（Left ventricular ejection fraction, LVEF）下降超过10%，将患者分为毒性组与无毒性组。比较第3化疗周期患者常规超声心动图指标、血清学指标以及二维超声斑点追踪显像（Two-dimensional speckle tracking imaging, 2D-STI）指标的差异。采用多因素COX回归筛选预测心脏毒性的指标并建立列线图探索患者出现心脏毒性的概率。结果：共随访148例患者，失访2例，剩余146例患者中心脏毒性的发生率为12.3%。多因素COX回归显示高敏感性心肌肌钙蛋白I变化量（delta-high sensitive cardiac troponin I,Δhs-cTnI）（P<0.05）、N-端脑钠肽前体变化量（delta-N-terminal pro -B-type natriuretic peptide, NT- pro BNP）（P<0.05）和整体纵向峰值应变变化量（delta-Global longitudinal strain, ΔGLS）（P<0.05）是预测乳腺癌术后化疗患者心脏毒性的独立风险指标。基于Δhs-cTnI、ΔNT- proBNP和ΔGLS建立的用于提示患者发生心脏毒性风险的列线图具有良好的辨别力（C-index 0.904）和校准度（χ2= 8.170，P = 0.417，Hosmer–Lemeshow检验）。结论：ΔGLS联合Δhs-cTnI、ΔNT- proBNP绘制的列线图有助于早期评估乳腺癌术后化疗患者发生心脏毒性的风险。 |
| 关键词: 心脏毒性 乳腺癌 二维斑点超声技术 高敏感性心肌肌钙蛋白 N-端脑钠肽前体 列线图 |
| DOI： |
| 投稿时间：2020-10-28修订日期：2020-11-15 |
| 基金项目:上海市卫生健康委员会卫生行业临床研究专项计划（序号 90） |
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| A nomogram including ultrasound combined with serological indicators for predicting the cardiotoxicity of breast cancer after chemotherapy |
| liyinghua,dayingfen,cuiwenting,jiangjinquan,zengjun,guoqiang,liuyi |
| (Huangpu Branch of Shanghai Ninth People''s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai) |
| Abstract: |
| Objective To explore the combination of ultrasound and serological indicators for predicting the cardiotoxicity of breast cancer after chemotherapy utilizing a nomogram. Methods Female breast cancer patients who underwent radical mastectomy and postoperative chemotherapy at our hospital were recruited. All patients were routinely administered with chemotherapy in two weeks after surgery. Patients were divided into toxic group and non-toxic group according to whether left ventricular ejection fraction (LVEF) decreased more than 10% occurred within one year after chemotherapy. Differences in ultrasound, serological examinations and two-dimensional speckle tracking imaging (2D-STI) during the third chemotherapy cycle were compared. Univariate and multivariate COX regression was used to find the independent influencing factors of cardiotoxicity in postoperative chemotherapy patients. Nomogram was established based on predictors to determine the probability of cardiotoxicity. Results A total of 148 patients were included in the study, and 2 patients were lost to follow-up. The incidence of cardiac toxicity was 12.3% in the remaining 146 patients. Multivariate COX regression showed that delta-high sensitive cardiac troponin (Δhs-cTnI) (P<0.05), delta-N-terminal pro -B-type natriuretic peptide (ΔNT-proBNP) (P<0.05) and delta-Global longitudinal strain (△GLS) (P<0.05) were independent risk indicators for predicting cardiotoxicity in patients undergoing chemotherapy after breast cancer surgery. The nomogram established based on Δhs-cTnI, ΔNT-proBNP and △GLS to indicate the risk of cardiotoxicity in patients had good discrimination (C-index 0.904) and calibration (χ2= 8.170, P = 0.417, Hosmer-Lemeshow test). Conclusion The nomogram established by 2D-STI combined with Δhs-cTnI and ΔNT-proBNP are helpful for assessment of the risk of cardiotoxicity in patients undergoing chemotherapy after breast cancer surgery. |
| Key words: cardiotoxicity breast cancer 2D-STI hs-cTnI NT- proBNP nomogram |
