超声心动图联合钠尿肽前体评价胸部肿瘤患者放疗后左心功能早期损伤

目的 探讨N端B型钠尿肽前体(NT-pro-BNP)联合超声心动图在评价胸部肿瘤患者放疗后左心功能早期损伤的价值.方法 对21例接受胸部全程放疗的胸部肿瘤患者,于放疗前1天、放疗后1天、1个月进行NT-pro-BNP和超声心动图检查,以组织多普勒获取二尖瓣环收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)和舒张晚期峰值速度(Aa)及Ea/Aa、二尖瓣舒张早期血流传播速度(Vp).常规超声心动图指标包括二尖瓣舒张早期峰值流速(E)、心房收缩期峰值流速(A)和E峰减速时间(DT),左心室舒张末期内径、左心房内径、射血分数(EF)和短轴缩短率(FS),同时计算E/Vp和E/Ea.结果 与放疗前相比,放疗后1天NT-pro-BNP明显升高(P＜0.05),放疗后1个月无明显变化(P＞0.05).放疗后Sa、Ea、Vp减低,Aa、E/Vp和E/Ea均升高;常规超声指标放疗前、后无明显变化(P均＞0.05).结论 胸部肿瘤患者接受放疗后,NT-pro-BNP有一定程度升高；组织多普勒、Vp、E/Vp和E/Ea可为早期左心功能损伤评价提供有价值的信息.

N-terminal B-type natriuretic peptide and echocardiography in assessment of acute radiation induced left heart injury in patients with thoracic neoplasms

Objective To analyze the value of N-terminal pro-BNP (NT-pro-BNP) and echocardiography in evaluating acute radiation induced left heart injury in patients with thoracic neoplasms. Methods NT-pro-BNP examination and echocardiography were performed in 21 patients with thoracic neoplasms 1 day before, 1 day and 1 month after thoracic radiotherapy (RT). The following parameters were obtained with tissue Doppler imaging (TDI): Mitral annulus peak velocities in systole (Sa), early disatiole (Ea), late diastole (Aa) and Ea/Aa, as well as mitral flow propagation velocity (Vp). Conventional parameters including the deceleration time (DT) of E wave, the peak early filling velocity (E), late diastolic filling velocity (A), the E/A ratio of mitral flow, left ventricular diameter, left atrium diameter, ejection fraction (EF) and fractional shortening (FS) were measured. The mitral inflow E velocity to tissue Doppler Ea (E/Ea) and the ratio of peak E velocity to Vp (E/Vp) were calculated. Results Compared with data before RT, NT-pro-BNP increased 1 day after RT (P<0.05), but no significant changed a month later (P>0.05). Sa, Ea and Vp deceased while Aa, E/Vp and E/Ea increased after RT. Conventional parameters had no significant changes after RT (all P>0.05). Conclusion After RT, NT-pro-BNP will increase to a higher level. TDI, Vp, E/Vp and E/Ea can provide valuable information for evaluating acute radiation induced left heart injury in patients with thoracic neoplasms.