2D-STI联合3D-HM在蒽环类药物对乳腺癌患者左心室功能损害评估中的应用

目的 探讨治疗期望值与脑卒中恢复期患者肢体功能的相关性研究。方法 选取2018年9月至2019年9月湖州市第一人民医院康复医学科收治的脑卒中偏瘫患者80例，采用Herth希望指数量表（herth hope index, HHI）对其进行问卷调查研究后，根据问卷中患者对治疗期望分数的高低，分为A组（12～30分，低治疗期望，n=40）和B组（31～48分，高治疗期望，n=40）。两组均采用相同的基础药物治疗和康复训练，比较两组治疗前后Fugl-Meyer运动功能（Fugl-Meyer assessment，FMA）评分、日常生活活动能力（activities of daily living，ADL）评分和Berg平衡量表（Berg balance scale, BBS）评分变化。结果 治疗4周后，两组患者的FMA评分、ALD评分和BBS评分均高于治疗前，且B组患者上升幅度较A组更明显，差异均有统计学意义（P<0.05）。结论 脑卒中恢复期患者经相同康复治疗后，治疗期望值高的患者相较于治疗期望值低的患者能在肢体功能恢复中取得更优的效果。

Application of two-dimensional speckle tracking imaging combined with three- dimensional echocardiography HeartModel in evaluating anthracycline induced damage to left ventricular function in breast cancer patients

Objective To investigate the application value of two-dimensional speckle tracking imaging (2D-STI) combined with three-dimensional echocardiography HeartModel (3D-HM) in evaluating anthracycline (ATC) induced damage to left ventricular function in breast cancer patients. Methods A total of 55 breast cancer patients who received chemotherapy at Jinhua People''s Hospital from March 2021 to June 2022 were selected and divided into normal electrocardiogram group (n=19) and abnormal electrocardiogram group (n=36) according to the electrocardiogram in the 4th cycle of chemotherapy. Parameters such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were measured by conventional echocardiography. Left ventricular global longitudinal strain (GLS) was measured by 2D-STI. 3D-LVEF, 3D-LVEDV and 3D-LVESV were measured by 3D-HM. Results At T2, the level of LVEF decreased significantly in both groups compared with that at T0 and T1 (P<0.05); the differences in LVEF, LVEDV and LVESV parameters at T0, T1 and T2 in both groups were not statistically significant (P>0.05); at T0 and T1, the differences in GLS levels in both groups were not statistically significant (P>0.05); at T2, the GLS levels of patients in both groups decreased significantly compared with those at T0 and T1 (P<0.05), and the GLS levels of patients in the abnormal ECG group were significantly lower than those in the normal ECG group (P<0.05); at T0 and T1, there was no statistically significant difference between the 3D-LVEF levels of patients in both groups (P>0.05); at T2, the 3D-LVEF levels of patients in both groups decreased significantly compared with those at T0 and T1 (P<0.05), and the 3D-LVEF levels of patients in the abnormal ECG group were lower than those in the normal ECG group (P<0.05). The differences in 3D-LVEDV and 3D-LVESV parameters at T0, T1 and T2 between the two groups were not statistically significant (P>0.05). Receiver operator characteristic curve analysis showed that area under the curve of GLS, 3D-LVEF alone and in combination to evaluate changes of left ventricular function in patients with abnormal electrocardiogram were 0.767, 0.739 and 0.788, respectively (P<0.05). Conclusion Breast cancer patients undergoing ATC-based chemotherapy have impaired left ventricular function regardless of whether the electrocardiogram is abnormal or not, and impaired left ventricular function is more obvious in patients with abnormal electrocardiogram. 2D-STI and 3D-HM can sensitively identify the changes of left ventricular function. Combination of the two can improve the prediction of impaired left ventricular function in patients with abnormal electrocardiogram.