Tei指数评价蒽环类药物对恶性肿瘤患儿的右心损害

目的分析Tei指数评价恶性肿瘤患儿使用蒽环类药物后右心功能损害的价值。 方法选择2015年6月至2016年12月河北医科大学第四医院收治的恶性肿瘤患儿34例（恶性肿瘤组），年龄2~14岁。同时选择同期该院体检的排除先天性心脏病、代谢型疾病及心血管损伤的非肿瘤儿童17名作为健康对照组，年龄2~13岁。对用药前、药物累计剂量为100、200、250 mg/m²时恶性肿瘤组患儿及健康对照组儿童进行超声心动图检查，测得三尖瓣舒张早期峰值流速E、舒张晚期峰值流速A；三尖瓣环收缩期运动速度峰值s′、舒张早期运动速度峰值e′及舒张晚期运动速度峰值a′；右心室侧壁及室间隔基底段等容收缩期（ICT_R、ICT_S）、等容舒张期（IRT_R、IRT_S）、射血时间（ET_R、ET_S），由公式Tei_R=（ICT_R＋IRT_R）/ET_R，Tei_S=（ICT_S＋IRT_S）/ET_S，Tei=（Tei_R+Tei_S）/2计算Tei指数及其他相关指标。采用t检验比较恶性肿瘤组患儿与健康对照组儿童用药前一般临床资料及常规超声心动图、组织多普勒及Tei指数相关指标；采用方差分析比较用药前及不同累计剂量时恶性肿瘤组患儿常规超声心动图、组织多普勒及Tei指数相关指标，进一步组间两两比较采用LSD-t检验；采用双变量Pearson相关分析法分析蒽环类药物累计剂量与ICT_R、Tei_R、Tei_S及Tei指数的相关性；采用直线回归分析法分析蒽环类药物累计剂量与Tei指数之间的关系。 结果恶性肿瘤组患儿与健康对照组儿童用药前一般临床资料及常规超声心动图、组织多普勒及Tei指数相关指标等差异均无统计学意义。用药前及不同累计剂量时肿瘤组患儿常规超声心动图、组织多普勒指标、ICT_S、IRT_S、ET_S、IRT_R、ET_R差异均无统计学意义。累计剂量达200、250 mg/m^2时ICT_R、Tei_R、Tei指数均高于用药前［（54±5）ms、（57±5）ms vs （50±5）ms，（0.40±0.03）、（0.41±0.03）vs （0.38±0.03），（0.39±0.03）、（0.41±0.03） vs （0.37±0.03）］，且差异均有统计学意义（t=3.406，P=0.001；t=6.256，P<0.001；t=2.875，P=0.003；t=4.625，P<0.001；t=2.857，P=0.004；t=5.000，P<0.001）；而其余任意2个时间点间ICT_R、Tei_R、Tei指数差异均无统计学意义。累计剂量达250 mg/m^2时Tei_S高于用药前［（0.40±0.04） vs （0.37±0.04）］，且差异有统计学意义（t=3.300，P=0.001）；而其余任意2个时间点间Tei_S差异均无统计学意义。蒽环类药物累计剂量与ICT_R、Tei_R、Tei指数呈正相关（r=0.482、0.397、0.417，P均<0.001），而与Tei_S相关性较小（r=0.279，P=0.001）。Tei指数随着蒽环类药物剂量的增加而升高，回归方程为Y=0.000 13X＋0.368。 结论组织多普勒中的Tei_S、ICT_R、Tei_R、Tei指数较常规超声心动图指标更敏感，且右心Tei指数随着蒽环类药物累计剂量的增加而升高。

The value of ultrasonography in evaluating right ventricular function in children after antharcycline therapy

ObjectiveTo explore the value of Tei index in evaluating right ventricular function in children with malignant disease after antharcycline therapy. MethodsThirty-four children in the malignant tumor group who were suffering from malignant tumor and hospitalized in the Fourth Affiliated Hospital of Hebei Medical University between June 2015 to December 2016 were evaluated for clinical cardiotoxicity. At the same time, 17 healthy non-tumor children taking examination during the same period in the same hospital without the congenital heart diseases, metabolic diseases, and cardiovascular injuries were selected as the healthy control group. We assessed right cardiac injury with echocardiography in the two group before the first cure, at cumulative doses of anthracycline 100, 200 and 250 mg/m², respectively. The parameters included tricuspid E velocity and tricuspid A velocity; tricuspid annulus peak systolic velocity (s′), tricuspid annulus early peak diastolic velocity (e′) and tricuspid annulus atrial contraction (a′); isovolumic contraction time of right ventricular lateral wall basal segment (ICT_R), isovolumic relaxation time of right ventricular lateral wall basal segment (IRT_R) and ejection time of right ventricular lateral wall basal segment (ET_R); isovolumic contraction time of interventricular septum basal segment (ICT_S), isovolumic relaxation time of interventricular septum basal segment (IRT_S) and ejection time of interventricular septum basal segment (ET_S), then calculated Tei index and other relevant parameters by formula Tei_R=(ICT_R+ IRT_R)/ET_R, Tei_S=(ICT_S+ IRT_S)/ET_S, Tei=(Tei_R+ Tei_S)/2. In the case group before anthracycline chemotherapy and the control group, the t-test was used to compare the general clinical data, conventional echocardiography, tissue doppler and Tei index related parameters of children, and the sex ratios were compared with the chi-test. Variance analysis was used to compare conventional echocardiography, tissue Doppler and Tei index related parameters before the first cure, at cumulative doses of anthracycline 100, 200 and 250 mg/m² in the malignant tumor group, and LSD-t test was used for further comparisons between groups. The bivariate Pearson correlation analysis was used to analyze the correlation between the cumulative dose of anthracycline and ICT_R, Tei_R, Tei_S and Tei index. The linear regression analysis was used to analyze the relationship between cumulative dose of anthracycline and Tei index. ResultsCompared to control group, there were no significant differences in the basic clinical data and ultrasonic parameters in the case group. There were no significant differences in conventional ultrasonic and tissue Doppler indicators, ICT_S, IRT_S, ET_S, IRT_R and ET_R before the first cure, at cumulative doses of anthracycline 100, 200 and 250 mg/m². ICT_R, Tei_R and Tei increased at cumulative doses of anthracycline 200 and 250 mg/m² compared with before antharcycline therapy, and the differences were statistically significant (54±5) ms, (57±5) ms vs (50±5) ms; (0.40±0.03), (0.41±0.03) vs (0.38±0.03); (0.39±0.03), (0.41±0.03) vs (0.37±0.03); t=3.406, P=0.001; t=6.256, P<0.001; t=2.875, P=0.003; t=4.625, P<0.001; t=2.857, P=0.004; t=5.000, P<0.001]. There were no significant differences at the other two timepoints. Tei_S increased at cumulative doses of anthracycline 250 mg/m² compared with before antharcycline therapy, and the difference was statistically sifnificant (0.40±0.04) vs (0.37±0.04), t=3.300, P=0.001]. There were no significant differences at the other two timepoints. Drug cumulative doses were positively correlated with ICT_R, Tei_R and Tei (r=0.482, 0.397, 0.417, all P<0.001), and had poor correlation with Tei_S (r=0.279, P=0.001). Tei increased with the drug cumulative doses, and the linear regression equation could be demonstrated as Y=0.000 13X+ 0.368. ConclusionTissue Doppler parameters, such as Tei_S, ICT_R, Tei_R, Tei, were more sensitive in detecting abnormalities of right cardiac function, particularly for Tei index, which increased with the accumulated dose.