三维斑点追踪技术联合血清肌钙蛋白评价蒽环类药物化疗后乳腺癌患者左心室收缩功能的改变

目的 将三维斑点追踪成像(3D-STI)技术与血清肌钙蛋白T(cTnT)相结合,评价乳腺癌患者蒽环类药物(ATC)化疗后左室整体收缩功能的改变,并探讨左、右乳腺癌患者化疗后心功能改变有无明显差异性.方法 59例行ATC化疗的乳腺癌术后的女性患者,分为A组(左乳术后27例)、B组(右乳术后32例),分别采集化疗前、化疗3个周期、化疗 6个周期这三个阶段二维超声心动图参数及3D-STI参数.比较两组各参数的差异,探讨两组患者化疗后心功能变化有无明显差异;若无差异则将两组合并成一个整体,行受试者工作特征曲线(ROC)分析整体三维应变参数评价左室整体收缩功能的临床价值.同时分别于相关时点测定cTnT值,分析其与左室整体面积应变(GAS)的相关性.结果 A、B两组左室GAS、整体长轴应变化疗中及化疗后较化疗前明显减低(P＜0.05).因为A、B两组间各对应参数差异无统计学意义,所以将A组、B组合成整体后,得到整体GAS的 ROC曲线下面积最大,为0. 923,以-30. 5％为截断值,敏感度为88. 1％,特异度为83. 6％.cTnT血清含量在化疗过程中出现不同程度的升高,差异有统计学意义(P＜0. 05).肌钙蛋白T与整体GAS呈负相关性(r=-0.667,P＜0.05).结论 3D-STI能够早期评估蒽环类药物化疗后左室整体收缩功能的改变,并cTnT血清含量随GAS降低而升高,但左、右侧乳腺癌的心功能改变无明显差异性.

Evaluation of left ventricular systolic function in patients with breast cancer after anthracycline chemotherapy by three-dimensional tracking technique combined with cardiac troponin

Objective To evaluate the left ventricular global systolic function in patients with breast cancer treated with anthracycline (ATC ) by three-dimensional speckle tracking imaging (3D-STI) technique and serum cardiac troponin T (cTnT), and to investigate whether there were significant differences in cardiac function after chemotherapy in left and right breast cancer patients. Methods A total of 59 breast cancer patients with postoperative anthracycline-based chemotherapy were recruited, which were divided into group A (27 cases with left breast surgery) and group B (32 cases with right breast surgery). Conventional echocardiography and 3D-STI derived parameters were measured before and at 3 and 6 anthracycline-based chemotherapeuticcycles. To compare the differences between the two groups of parameters, and compare whether there was statistically significant changes in cardiac function between the two groups of patients after chemotherapy, if not, then the two groups combined into a whole, the receiver operating characteristic (ROC ) curve analysis of the overall three-dimensional strain parameters of left ventricular systolic function value. The level of serum cTnT at different time points were determined and the correlation between cTnT and global area strain (GAS) was analyzed. Results Global area strain (GAS) and global longitudinal strain (GLS) were significantly lower than those before chemotherapy (P ＜0. 05). The parameters between group A and group B had no signifcant difference, so we combined the two groups into a whole. The area under the ROC curve of the whole GAS was 0. 923, which is the largest, and its optimal cut-off value was-30. 5％, with a sensitivity of 88. 1％ and a specificity of 83. 6％. The serum content of cTnT increased significantly during the whole therapy, the difference was statistically significant (P ＜ 0. 05). Troponin T was negatively correlated with overall GAS(r=-0. 667, P ＜ 0. 05). Conclusion 3D-STI can quantitatively evaluate the left ventricular total systolic function of patients treated with anthracycline, and the serum cTnT increased with GAS decreased, but there is no significant difference in left and right breast cancer.