CAJ | 학술논문

目的应用血清肌钙蛋白测定和超声二维斑点追踪成像(2D-STI)动态观察紫杉醇联合顺铂方案的心脏毒性。方法选取病理证实的43例恶性肿瘤患者进行追踪观察。每例分为化疗前、首次化疗后、全疗程一半、全疗程结束4个阶段。进行血清肌钙蛋白T( cTnT)、肌钙蛋白I( cTnI)检测及心电图检查,同时应用2D-STI检测左室收缩期整体纵向应变( GSL)及应变率( GSRs)、舒张早期及舒张晚期整体纵向应变率( GSRe、GSRa)。结果初次化疗后、全疗程一半、全疗程结束时cTnT、cTnI依次逐渐升高,与化疗前比较,差异均有统计学意义(P<0.01)。化疗中期GSRe、GSRa减低差异有统计学意义(P<0.01),GSL、GSRs虽有所减低但差异无统计学意义( P>0.05)；化疗结束时GSL、GSRs、GSRe、GSRa均减低,差异有统计学意义( P<0.01)。结论紫杉醇联合顺铂方案具有一定的心脏毒性,血清肌钙蛋白水平的测定和2D-STI结合在观察化疗药物的心脏毒性中具有很高的价值。
목적응용혈청기개단백측정화초성이유반점추종성상(2D-STI)동태관찰자삼순연합순박방안적심장독성。방법선취병리증실적43례악성종류환자진행추종관찰。매례분위화료전、수차화료후、전료정일반、전료정결속4개계단。진행혈청기개단백T( cTnT)、기개단백I( cTnI)검측급심전도검사,동시응용2D-STI검측좌실수축기정체종향응변( GSL)급응변솔( GSRs)、서장조기급서장만기정체종향응변솔( GSRe、GSRa)。결과초차화료후、전료정일반、전료정결속시cTnT、cTnI의차축점승고,여화료전비교,차이균유통계학의의(P<0.01)。화료중기GSRe、GSRa감저차이유통계학의의(P<0.01),GSL、GSRs수유소감저단차이무통계학의의( P>0.05)；화료결속시GSL、GSRs、GSRe、GSRa균감저,차이유통계학의의( P<0.01)。결론자삼순연합순박방안구유일정적심장독성,혈청기개단백수평적측정화2D-STI결합재관찰화료약물적심장독성중구유흔고적개치。
Objective To observe heart functions of the patient with cancer receiving combined chemotherapy of paclitaxel plus cisplatin through troponin test and speckle tracking echocardiography. Methods 43 patients who had been scheduled to receive combined chemotherapy of paclitaxel plus cisplatin were recruited in the study. Ser-um cTnT and cTnI levels were measured before chemotherapy,after the first cycle of chemotherapy,middle cycle of chemotherapy and after the last cycle of chemotherapy. In all patients, the lobal longitudinal systolic strain( GSL) and strain rate(GSRs)of the LV as well as peak early-diastolic strain rate (GSRe) and peak late-diastolic strain rate ( GSRa) were measured by two-dimensional speckle tracking echocardiography at every stage. Results The patients' serum cTnT and cTnI level after chemotherapy were increased gradually(P<0.01). After the last stage of chemotherapy the GSL and GSRs decreased significantly, having made significance in statistics ( P <0.01 ) . Compared with those before chemotherapy, the patients' GSRe and GSRa in the early stage of chemotherapy had no significant difference (P>0. 05), but compared to those of the middle and last stage of chemotherapy, significant difference (P<0.01) existed. Conclusion Paclitaxel plus cisplatin induce certain subclinical myocardial injury to patient's heart. Cardiac troponin level and speckle tracking echocardiography have important value in the obser-vation of heart functions of the patients with cancer receiving chemotherapy.