自动心肌运动定量技术评价蒽环类药物致白血病儿童心脏毒性的价值

目的：探讨自动心肌运动定量（aCMQ）技术评价急性淋巴细胞白血病（ALL）儿童使用蒽环类药物化疗后亚临床左室功能损害的价值。方法：选取2021年11月至2022年1月在温州医科大学附属第二医院育英儿童医院采用DVLD方案诱导化疗的30例ALL患儿作为白血病组，在化疗前和化疗3个月后行超声心动图检查。同期选取性别匹配的26例健康者作为对照组。运用常规超声心动图获取左室射血分数（LVEF）、左室短轴缩短率（LVFS）、二尖瓣口舒张早期峰值流速（E）与晚期最大峰值流速（A）比值（E/A）、E与二尖瓣环舒张早期血流峰值（e’）比值（E/e’）、e’与二尖瓣环舒张晚期血流峰值（a’）比值e’/a’。运用aCMQ技术获得两腔心纵向应变（AP2LS）、三腔心纵向应变（AP3LS）、四腔心纵向应变（AP4LS）及整体纵向应变（LVGLS），左室短轴基底段环向应变（SAXBCS）、左室短轴中间段环向应变（SAXMCS）、左室短轴心尖段环向应变（SAXACS）及整体环向应变（LVGCS），并进行比较分析。结果：白血病组与对照组年龄差异无统计学意义（P ＞0.05）；对照组、化疗前组及化疗后组LVEF、LVFS、E/A、E/e’、e’/a’差异无统计学意义（P ＞0.05），化疗前组AP4LS、AP3LS、AP2LS、GLS、SAXBCS、SAXMCS、SAXACS及GCS值与对照组比较，差异无统计学意义（均P ＞0.05）；化疗后组SAXBCS、SAXMCS值与化疗前和对照组比较，差异无统计学意义（P ＞0.05）；化疗后组AP4LS、AP3LS、AP2LS、GLS、SAXACS及GCS参数绝对值低于对照组和化疗前组，差异有统计学意义（P ＜0.05）。结论：aCMQ技术能早期发现儿童ALL蒽环类药物化疗所致亚临床左室功能损害，可作为一种评估左室收缩功能相对准确的方法。

The value of automated cardiac motion quantification technique in evaluating subclinical anthracyclineinduced cardiotoxicity in children with acute lymphoblastic leukemia

Objective: To investigate the value of automated cardiac motion quantification (aCMQ) in evaluating subclinical anthracycline-induced cardiotoxicity in children with acute lymphoblastic leukemia (ALL). Methods: Altogether 30 children with ALL who were treated with DVLD induced chemotherapy in the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University from November 2021 to January 2022 were selected as leukemia group. Echocardiography was performed before chemotherapy and 3 months later.Twenty-six healthy subjects were selected as the control group. Transthoracic echocardiography was performed to obtain left ventricular ejection fraction (LVEF), left ventricular short axis shortening (LVFS), E/A, E/e’, and e’/a’. The longitudinal strains of 2 chamber (AP2LS), 3 chamber (AP3LS), 4 chamber (AP4LS) and global longitudinal strain (LVGLS) were obtained by aCMQ technique. The annular strains of left ventricular short-axis basal segment (SAXBCS), left ventricular short-axis intermediate segment (SAXMCS), left ventricular short-axis apical segment(SAXACS) and global circular strain (LVGCS) were compared and analyzed. Results: There were no significant differences in age between the leukemia group and the control group (P>0.05). There were no significant differences in LVEF, LVFS, E/A, E/e’ and e’/a’ between the control group, the pre-chemotherapy group and the post-chemotherapy group (P>0.05). The values of AP4LS, AP3LS, AP2LS, GLS, SAXBCS, SAXMCS, SAXACS and GCS in the pre-chemotherapy group were compared with those in the control group, with no significant difference (P>0.05). There was no significant difference in SAXBCS and SAXMCS between the group after chemotherapy and the control group before and after chemotherapy (P>0.05). The absolute values of AP4LS,AP3LS, AP2LS, GLS, SAXACS and GCS in the post-chemotherapy group were lower than those in the control group and the pre-chemotherapy group, with statistical difference (P<0.05). Conclusion: aCMQ can be used as a relatively accurate method for evaluating subclinical anthracycline-induced cardiotoxicity in children with ALL.