三维斑点追踪技术评价蒽环类药物对淋巴瘤患者左室心肌功能损害的价值

目的 探讨三维斑点追踪成像(3D-STI)技术评价蒽环类药物对弥漫大B细胞淋巴瘤(DLBCL)患者早期左心室功能损害的价值.方法 选取2014年12月至2016年10月安徽医科大学第一附属医院行蒽环类药物化疗的DLBCL患者28例,分别于化疗前及化疗2、4、6个周期(即累计剂量达100、200、300 mg/m2)后24~48 h内行二维超声心动图及3D-STI检查,获取常规二维超声心动图数值及左心室整体面积应变(GAS)、整体纵向应变(GLS)、整体圆周应变(GCS)、整体径向应变(GRS),并进行统计学分析.结果 GAS、GLS在化疗4个周期(-28.66±2.67)%,(-16.49±1.94)%]及6个周期(-25.14±2.73)%,(-15.12±1.97)%]时,与化疗前(-34.86±2.90)%,(-18.36±2.32)%]及化疗2个周期(-34.05±2.09)%,(-17.75±1.91)%]时比较显著降低,差异有统计学意义(P<0.05).Pearson相关分析显示,GAS与多柔比星累计剂量呈负相关(r=-0.815,P<0.05).整个化疗进程中,GCS、GRS无明显变化.结论 GAS对DLBCL患者蒽环类药物化疗后出现早期左心室功损害的敏感性较高.3D-STI技术可以发现早期蒽环类药物所致的心脏毒性.

Evaluation of left ventricular myocardial dysfunction induced by anthracyclines in patients with diffuse large B- cell lymphoma by three-dimensional speckle tracking imaging

Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI) technology in evaluating the left ventricular myocardial dysfunction in patients with diffuse large B-cell lymphoma after receiving anthracyclines.Methods Conventional echocardiography and 3D-STI parameters were measured from 28 patients with DLBCL before chemotherapy,and during 24-48 hours after 2(100 mg/m2), 4(200 mg/m2) and 6(300 mg/m2) chemotherapy cycles,global area strain(GAS),global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS)were obtained for evaluation and analysis.Results Compared with before chemotherapy and 2 chemotherapy cycles, GAS and GLS decreased statistically after 4 and 6 chemotherapy cycles. Moreover,Pearson correlation analysis showed GAS was significantly associated with cumulative anthracycline dose (r=-0.834,P<0.05).However, the variations on GSC and GRS showed no significant degradation during the whole chemotherapy.Conclusion GAS shows a high sensitivityto detect subclinical left ventricular dysfunction in patients with DLBCL who undertake anthracycline therapy. 3D-STI can be used for an early exploration of the cardiotoxicity of anthracycline.