心肌背向散射积分参数评价蒽环类抗肿瘤药心脏毒性的临床研究

目的 :探讨背向散射积分参数分析技术在评价蒽环类抗肿瘤药 (ATC)心脏毒性方面的应用价值。方法 :应用 HP Sonos550 0型超声诊断仪及其配置的背向散射联机分析软件测定 83例接受 ATC化疗的肿瘤患者及 50例正常对照组心肌背向散射积分参数 :心肌背向散射积分均值 (IBS) ;背向散射积分的心动周期变化幅度 (CVIB) ;心肌校正的背向散射积分均值 (IBS% )和背向散射积分周期变异率 (CVIB% )。结果 :ATC化疗组与对照组心肌 IBS均呈周期性变化 ,但 ATC化疗组变化幅度明显减低 ;ATC化疗组心肌 IBS%较对照组明显增高 (P<0 .0 5) ,CVIB和 CVIB%则较对照组明显减低 (P<0 .0 5,P<0 .0 1) ;ATC化疗组中 3 0例 (3 6.1% )患者出现左心室舒张功能指标异常 ,其中 E/A明显低于对照组。但左心室收缩功能参数和室间隔 (IVS)及左室后壁 (L VPW)的室壁增厚率 (Δ T% )在 ATC化疗组和对照组之间无显著性差异 ;IBS参数与 ATC累积剂量、距首次化疗时间、心功能参数及相应节段的室壁增厚率均无显著相关性。结论 :ATC化疗组患者心肌组织背向散射积分参数与对照组显著不同 ,背向散射积分参数测定可作为评价 ATC早期心脏毒性的手段之一。

Clinical Study on Myocardial Integrated Backscatter Parameters in Assessment of Cardiotoxicity of Patients Treated with Anthracycline

Objective:To evaluate the clinical valu e of integrated backscaater (IBS) measurement in patients receiving cardiotoxic anthracycline for malignant chemotherapy.Methods:Eighty-three patients during or after anthracycl ine chemotherapy for malignancy (ATC group) were studied,and fifty age-and gend er-matched volunteers without cardiac involvement were served as normal subject s(control group) Using a color Doppler ultrasound system(Agilent Sonos 5500),in tegrated backscatter (IBS) ,cyclic variation of IBS (CVIB),normalized IBS(IBS%)a nd normalized cyclic variation of IBS(CVIB%) were obtained at parasternal long- axis view Standard echocardiographic measures of left ventricular function wer e also made.Results:IBS changed periodically in normal subjects,and t he value was maximal at the end diastole and minimal at the end systole IBS in patients showed similar periodial changes,but the amplitude of the change was lo wer than that of normal subjects IBS% was significantly higher while CVIB and CVIB% were lower in ATC group compared to those in the control group No signif icant difference was found in systolic parameters of left ventricle and the thic kening rate of the inter-ventricular septum and posterior wall whereas diastoli c parameters were different between ATC group and control group One or more dia stolic variables(the ratio of E and A wave,deceleration time of E wave and isovo lumic relaxation times)were abnormal in 30 patients(36%) in ATC group IBS para meters have no relationship with the culmulative dosage of ATC,the initial time of the first dose,function parameters of left ventricle,the thickening rate of the interventriclur septum and left ventricular posterior wall.Conclusions:Myocardial integrated backscatter parameters o f patients treated with ATC were significantly different from those of normal su bjects.IBS parameters may be valuable to assess the early cardiotoxicity of anth racycline.