无创监测表阿霉素心脏毒性-组织多普勒超声心动图

目的： 利用组织多普勒和常规超声心动图评估淋巴瘤患者表阿霉素心脏毒性。 方法： 20例接受表阿霉素化疗的淋巴瘤患者，表阿霉素总累计量(450±75)mg/m2，每个疗程治疗前进行组织多普勒和常规超声心动图检查。健康对照组20例。常规超声心动图指标包括左室舒张末内径（LVEDD），左室收缩末内径（LVESD），左室射血分数（LVEF），二尖瓣口血流速度（早期速度E,晚期速度A及两者比值E/A）；组织多普勒指标有二尖瓣环左室侧壁处组织多普勒峰值速度（收缩峰速S，舒张早期峰速E，舒张晚期峰速A及E/A）。 结果： 与治疗前相比，常规超声心动图收缩期指标LVEDD、LVESD、LVEF在累计量达到450 mg/m2才出现显著差别［LVEDD (55.4±10.2)mm vs (42.2±8.1)mm；LVESD (34.2±7.9)mm vs (24.5±5.3)mm；LVEF (58.1±6.5)% vs (68.2±7.4)%,P<0.05］，常规超声心动图舒张期指标E/A在累计量达到375 mg/m2才出现显著差别［(0.88±0.16) vs (1.22±0.21)，P<0.05］；而组织多普勒收缩期指标S在累计量达到300 mg/m2就出现显著差别［(8.1±2.5)cm/s vs (10.2±3.6)cm/s，P<0.05］，组织多普勒舒张期指标E/A在累计量达到225 mg/m2即出现统计学意义的差别［(0.90±0.18) vs (1.13±0.23)，P<0.05］。与健康对照组相比，20例淋巴瘤患者第一次治疗前各指标无明显差别（P>0.05）。 结论： 在监测表阿霉素心脏毒性上，组织多普勒超声心动图较常规超声心动图能较早期和较敏感发现变化，且舒张功能变化早于收缩功能变化。

Evaluation of epirubicin cardiotoxity by tissue doppler echocardiography

AIM: To evaluate cardiotoxity effects of epirubicin chemotherapy in lymphoma patients by using conventional and tissue doppler echocardiography.METHODS: Twenty lymphoma patients with epirubicin chemotherapy ［total dose of （450±75） mg/m2］ underwent conventional and tissue doppler echocardiography before every period, twenty healthy volunteers served as control.Conventional echocardiography parameters included left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter (LVESD)，left ventricular ejection fraction (LVEF)，early and late wave of mitral valve flow (E/A)；Tissue doppler echocardiography parameters included systolic wave (S) and early, late wave of pulse tissue doppler in lateral wall of mitral annulus.RESULTS: Compared to baseline before first period, conventional echocardiography systolic parameters, LVEDD, LVESD, LVEF changed significantly at total dose of 450 mg/m2 (P<0.05)，conventional echocardiography diastolic parameter E/A changed significantly at total dose of 375 mg/m2 (P<0.05)；While tissue Doppler echocardiography systolic parameter S changed significantly at total of dose 300 mg/m2 (P<0.05)，tissue Doppler echocardiography diastolic parameter E/A changed significantly at total of dose 225 mg/m2 (P<0.05 ).Compared to healthy control, there were no significant change every parameters of baseline before first period in twenty lymphoma patients (P>0.05).CONCLUSION: Tissue doppler provides a new sensitive and early method to evaluate LV function in monitoring epirubicin cardiotoxity compared to conventional echocardiography, and diastolic parameter alters earlier than systolic parameter.