二维斑点追踪技术在评价蒽环类药物治疗恶性淋巴瘤继发心功能损害中的应用

doi:10.13481/j.1671-587x.20170623

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (06): 1193-1198.doi: 10.13481/j.1671-587x.20170623

二维斑点追踪技术在评价蒽环类药物治疗恶性淋巴瘤继发心功能损害中的应用

张帆, 郑逸, 杨晓红, 叶彩芬, 王良玉

中山大学附属汕头医院超声科, 广东汕头 515031

收稿日期:2017-03-13 出版日期:2017-11-28 发布日期:2017-12-01
通讯作者: 王良玉,主任医师(Tel:0754-88550450-8045,E-mail:13902747408@139.com) E-mail:13902747408@139.com
作者简介:张帆(1989-),男,广东省汕头市人,医师,医学硕士,主要从事超声医学方面的研究。
基金资助:
广东省卫计委医学科研基金资助课题（A2010584）

Application of two dimension speckle tracking imaging in evaluating on cardiac dysfunction in patients with malignant lymphoma after anthracycline treatment

ZHANG Fan, ZHENG Yi, YANG Xiaohong, YE Caifen, WANG Liangyu

Department of Ultrasound, Affiliated Shantou Hospital, Sun Yat-sen University, Shantou 515031, China

Received:2017-03-13 Online:2017-11-28 Published:2017-12-01

摘要/Abstract

摘要： 目的：应用二维斑点追踪技术（2D-STI）检测非霍奇金淋巴瘤（NHL）患者使用蒽环类药物（ANTH）化疗后的左室心肌组织生物力学参数改变，探讨2D-STI评价和监测ANTH化疗所致心脏功能损害的价值。方法：选择NHL初发住院患者37例（ANTH化疗组，行CHOP方案化疗）及与之相匹配的健康受试者20人（正常对照组）。采用2D-STI检测正常对照组和ANTH化疗组受试者化疗前及化疗第1、2和3个周期患者心脏整体纵向应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）及左室扭转角度（LVtw），计算对应的GLS×LVtw值。结果：正常对照组受试者和ANTH化疗组患者化疗前一般临床参数比较差异无统计学意义（P>0.05）；ANTH化疗组患者化疗后GLS、GRS及GCS低于化疗前和正常对照组（P<0.05），GLS下降幅度较GRS和GCS明显；化疗第3个周期超声指标符合心肌毒性诊断标准的4例患者的GLS、GRS、GCS、GLS×LVtw降低；以△GLS×LVtw=-64.53%×°为截断点预测发生心肌毒性的灵敏度为94%，特异度为66.7%，约登指数最大为0.667。结论：2D-STI可以检测左室心肌组织生物力学参数的早期改变，在早期检测ANTH所致心功能损害方面较敏感，可能成为未来预测ANTH化疗继发早期心肌毒性的有效方法。

关键词: 应变, 蒽环类药物, 心脏毒性, 心功能, 二维斑点追踪技术, 扭转

Abstract: Objective:To assess the changes of myocardial biomechanical parametres of left ventricle of the patients with non-Hodgkin lymphoma(NHL) after anthracycline(ANTH) treatment by using two dimension speckle tracking imaging(2D-STI),and to study the value of 2D-STI in evaluating and monitoring the early cardiac dysfunction of the NHL patients induced by ANTH treatment. Methods:A total of 37 hospital patients who were firstly diagnosed as NHL (ANTH chemotherapy group) and 20 healthy volunteers (normal control group) were selected. The global longitudinal strain(GLS), global radial strain(GRS), global circumferential strain (GCS) and left ventricle twist(LVtw) of the subjects in two groups were detected before chemotherapy and 1,2,3 weeks after chemotherapy with 2D-STI; the GLS×LVtw was calculated. Results:There were no significant differences in the general clinical parameters of the subjects between normal control group and ANTH chemotherapy group before chemotherapy (P>0.05);the values of GLS, GRS and GCS of the patients in ANTH chemotherapy group after ANTH chemotherapy were decreased than those in normal control group and before ANTH chemotherapy(P<0.05),and GLS had the most obvious change. The GLS,GRS,GCS and GLS×LVtw of the patients after 3 cycles of chemotherapy in ANTH chemotherapy group were decreased (P>0.05).Four patients meet the diagnostic criteria of cardiac toxicity in the couse of chemotherapy.The sensitivity was 94%, the specificity was 66.7%, and the maximal Youden index was 0.667 when the △ GLS×LVtw=-64.53%×° was used as the cut-off point in predicting the occurrence of myocardial toxicity. Conclusion:2D-STI can detect the early changes of biomechanical parameters of left ventricular myocardium with highly sensitive in predicting early myocardial toxicity and early cardiac dysfunction caused by ANTH chemotherapy. It may be an effective way to predict the early myocardial toxicity of ANTH chemotherapy in the future.

Key words: strain, twist, two dimension speckle tracking imaging, anthracycline, cardiotoxicity, cardiac function

中图分类号:

R541.4

张帆, 郑逸, 杨晓红, 叶彩芬, 王良玉. 二维斑点追踪技术在评价蒽环类药物治疗恶性淋巴瘤继发心功能损害中的应用[J]. 吉林大学学报(医学版), 2017, 43(06): 1193-1198.

ZHANG Fan, ZHENG Yi, YANG Xiaohong, YE Caifen, WANG Liangyu. Application of two dimension speckle tracking imaging in evaluating on cardiac dysfunction in patients with malignant lymphoma after anthracycline treatment[J]. Journal of Jilin University Medicine Edition, 2017, 43(06): 1193-1198.

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二维斑点追踪技术在评价蒽环类药物治疗恶性淋巴瘤继发心功能损害中的应用

Application of two dimension speckle tracking imaging in evaluating on cardiac dysfunction in patients with malignant lymphoma after anthracycline treatment

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