Tei指数和组织多普勒联合N端B型钠尿肽前体评价右心早期放射性损伤

目的探讨Tei指数和组织多普勒成像(TDI)联合N端B型钠尿肽前体(NT-proBNP)评价胸部肿瘤患者放疗后右心早期损伤的价值。方法对21例接受胸部全程放疗的胸部肿瘤患者,于放疗前、放疗后1天和1个月行NT-proBNP和超声心动图检查,检查指标:①Tei指数;②常规指标,包括三尖瓣血流舒张早期峰值流速(E)、心房收缩期峰值流速(A)、E/A和E峰减速时间;右心室舒张末期内径和右心房收缩末期内径,右心室面积变化率及三尖瓣瓣环运动幅度;③TDI:三尖瓣环内侧和外侧处收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa)及E/Ea。结果与放疗前相比,NT-proBNP在放疗后1天明显升高(P<0.05),放疗后1个月降低;放疗后Tei指数升高,Sa、Ea减低,Aa和E/Ea均升高;常规指标在放疗前后无明显变化。结论胸部肿瘤患者放疗后出现右心功能早期轻度损伤;Tei指数、DTI联合NT-proBNP可对其进行评价。

Tei index and tissue Doppler imaging combined with N-terminal proBNP in evaluation of acute radiation induced right heart injury

Objective To explore the value of Tei index,tissue Doppler imaging(TDI) combined with N-terminal proBNP(NT-proBNP) in evaluating acute radiation induced right heart injury.Methods NT-proBNP and echocardiography were performed in 21patients underwent thoracic radiotherapy(RT) at the timepoint of before RT,1day and 1month after RT.The following echocardiographic parameters were obtained : ①Tei index;②Conventional parameters,including the deceleration time of E wave,peak early filling velocity(E),late diastolic filling velocity(A),E/A ratio and deceleration time of E peak,as well as right ventricular end diastolic diameter,right atrium end systolic diameter,right ventricular fractional area change and tricuspid annular plane systolic excursion;③TDI parameters : Mitral annulus peak velocities in systole(Sa),early diastole(Ea),late diastole(Aa).Then the mitral inflow E velocity to tissue Doppler Ea(E/Ea) was calculated.Results Compared with data before RT,NT-proBNP increased 1day after RT but declined to a low level a month later(P<0.05),while Sa and Ea decreased,Tei index,Aa and E/Ea increased,but conventional parameters had no significant changes(all P>0.05).Conclusion After RT,TDI,Tei index and NT-proBNP can provide valuable information for evaluating acute radiation induced right heart injury.