复合超声心动图在检测淋巴瘤化疗所致心脏毒性中的应用价值

doi:10.3760/cma.j.issn.1007-1245.2022.16.004

摘要/Abstract

摘要： 目的　探讨超声复合技术在动态监测淋巴瘤化疗所致心脏毒性中的应用价值。方法　选择2020年1月至2021年12月河南科技大学第一附属医院就诊的非霍奇金淋巴瘤化疗患者28例（化疗组），其中男12例、女16例，年龄（51.22±10.17）岁；同期选择健康志愿者30例为对照组，其中男12例、女18岁，年龄（50.19±12.06）岁。所有患者在化疗后2周期、4周期、6周期采用实时二维超声心动图（RT-2DE）、组织多普勒成像（TDI）、二维斑点追踪成像（2D-STI）检测各心功能指标。观察两组左心室射血分数（LVEF）、左心室前后径（LV）、左心房前后径（LA）、E峰、A峰、E/A值、二尖瓣E峰减速时间（DT）、血流频谱舒张早期速度（E）与二尖瓣环舒张早期运动峰速度（e’）比值、左心室整体圆周应变（LVGCS）、左心室整体径向应变（LVGRS）、左心室整体纵向应变（LVGLS）、左心室扭转角度峰值（LVPtw）。计量资料采用独立样本t检验或单因素方差分析，计数资料采用卡方检验。结果　化疗组化疗后2周期、4周期LVEF、LV、LA、E峰、A峰、E/A与对照组比较，差异均无统计学意义（均P>0.05）；化疗2周期化疗组DT与对照组比较，差异无统计学意义（P>0.05），化疗4周期化疗组DT为（213.16±21.23）ms，与对照组（181.26±20.23）ms比较，差异有统计学意义（P<0.05）。化疗组化疗后6周期LVEF为（49.01±4.12）%、LV为（56.68±4.32）mm、LA为（43.64±4.02）mm、E峰为（78.36±12.20）cm/s、A峰为（90.96±12.61）cm/s、E/A为（0.76±0.21）、DT为（256.23±32.14）ms，与对照组比较差异均有统计学意义（均P<0.05）。化疗组化疗后2周期e’、E/e’与对照组比较，差异均无统计学意义（均P>0.05）；化疗组化疗后4周期e’为（8.22±1.27）cm/s、E/e’为（18.17±3.12），化疗6周期e’为（4.29±2.17）cm/s、E/e’为（20.17±4.06），与对照组比较差异均有统计学意义（均P<0.05）。化疗组化疗后2周期、4周期、6周期LVGRS、LVGCS、LVGLS、LVPtw与对照组比较，差异均有统计学意义（均P<0.05）。结论　接受蒽环类药物化疗的肿瘤患者会导致心脏毒性，RT-2DE联合TDI及2D-STI能更早期更敏感地检测到化疗所致的心脏毒性，对指导临床具有重要意义。

关键词: RT-2DE, TDI, 2D-STI, 肿瘤, 化疗, 心脏毒性

Abstract: Objective　To investigate the application value of composite echocardiography technique in dynamically monitoring cardiotoxicity caused by lymphoma chemotherapy. Methods　A total of 28 non-Hodgkin lymphoma patients underwent chemotherapy in The First Affiliated Hospital of Henan University of Science and Technology, including 12 males and 16 females, aged (51.22±10.17) years; 30 healthy volunteers were selected as controls during the same period, including 12 males and 18 females, aged (50.19±12.06) years. Real-time two-dimensional echocardiography (RT-2DE), tissue Doppler imaging (TDI), and two-dimensional speck-tracking imaging (2D-STI) were used to detect the cardiac function indexes in all patients after 2, 4, and 6 cycles of chemotherapy. The left ventricular ejection fraction (LVEF), left ventricular anterior diameter (LV), left atrial anterior diameter (LA), peak E, peak A, E/A, mitral peak E deceleration time (DT), the ratio of early diastolic velocity of blood flow spectrum (E) to early diastolic peak velocity of mitral annulus (e'), left ventricular global circumferential strain (LVGCS), left ventricular global radial strain (LVGRS), left ventricular global longitudinal strain (LVGLS), and peak left ventricular twist angle (LVPtw) were observed and compared in both groups. Independent sample t test or one-way ANOVA was used for the measurement data, and Chi-square test was used for the count data. Results　There were no statistically significant differences in the LVEF, LV, LA, peak E, peak A, and E/A between the chemotherapy group and the control group after 2 and 4 cycles of chemotherapy (all P>0.05). There was no statistically significant difference in the DT between the chemotherapy group and the control group after 2 cycles of chemotherapy (P>0.05), but there was a statistically significant difference after 4 cycles of chemotherapy [(213.16±21.23) ms vs. (181.26±20.23) ms] (P<0.05). After 6 cycles of chemotherapy, the LVEF, LV, LA, peak E, peak A, E/A, and DT in the chemotherapy group were (49.01±4.12)%, (56.68±4.32) mm, (43.64±4.02) mm, (78.36±12.20) cm/s, (90.96±12.61) cm/s, (0.76±0.21), and (256.23±32.14) ms, with statistically significant differences compared with those in the control group (all P<0.05). There were no statistically significant differences in the e' and E/e' between the chemotherapy group and the control group after 2 cycles of chemotherapy (both P>0.05). In the chemotherapy group, the e' was (8.22±1.27) cm/s and the E/e' was (18.17±3.12) after 4 cycles of chemotherapy, the e' was (4.29±2.17) cm/s and the E/e' was (20.17±4.06) after 6 cycles of chemotherapy, with statistically significant differences compared with those in the control group (all P<0.05). There were statistically significant differences in the LVGRS, LVGCS, LVGLS, and LVPtw between the chemotherapy group and the control group after 2, 4, and 6 cycles of chemotherapy (all P<0.05). Conclusion　Chemotherapy with anthracycline for tumor patients can lead to cardiotoxicity, and RT-2DE combined with TDI and 2D-STI can detect the cardiotoxicity caused by chemotherapy earlier and more sensitively, which is of great significance for guiding clinical practice.

Key words: RT-2DE, TDI, 2D-STI, Tumor, Chemotherapy, Cardiotoxicity

薛静　张周龙　陈胜江　袁小志　段利科　王慧芬. 复合超声心动图在检测淋巴瘤化疗所致心脏毒性中的应用价值[J]. 国际医药卫生导报, 2022, 28(16): 2236-2240.

Xue Jing, Zhang Zhoulong, Chen Shengjiang, Yuan Xiaozhi, Duan Like, Wang Huifen. Application value of composite echocardiography technique in detecting cardiotoxicity caused by lymphoma chemotherapy[J]. International Medicine and Health Guidance News, 2022, 28(16): 2236-2240.

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