CAJ | 학술논문

目的：探讨三维斑点追踪显像(three-dimensional speckle tracking imaging,3D-STI)技术检测蒽环类药物(anthracycline,ATC)对乳腺癌患者左室心肌功能早期损害的价值。方法乳腺癌术后患者63例,均采用6周期以表柔比星为主的化疗方案,分别于化疗前及表柔比星累计剂量达120 mg/m2、240 mg/m2、360 mg/m2后24~48 h 内常规进行心电图、二维超声心动图及3D-STI 监测。以 ROC 曲线下面积评价左室整体面积应变(GAS)、整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)检测左室功能早期损害准确性,并寻找其检测敏感性及特异性的截断值。21例女性志愿者作为对照组。结果GAS 和 GLS 在表柔比星累计剂量达240 mg/m2、360 mg/m2时较对照组、化疗前明显减低(P <0.05),其中 GAS 的 ROC 曲线下面积为0.974,截断值为-31.5%,判断蒽环类药物对左室功能损害的敏感性为87.1%,特异性为92.9%。GAS 与表柔比星累计剂量之间显著相关(r =-0.834,P <0.01)。结论化疗进程中 GAS 检测蒽环类药物心脏毒性的敏感性、特异性较高,3D-STI 是检测蒽环类药物对乳腺癌患者左室心肌功能早期损害的可靠方法。
목적：탐토삼유반점추종현상(three-dimensional speckle tracking imaging,3D-STI)기술검측은배류약물(anthracycline,ATC)대유선암환자좌실심기공능조기손해적개치。방법유선암술후환자63례,균채용6주기이표유비성위주적화료방안,분별우화료전급표유비성루계제량체120 mg/m2、240 mg/m2、360 mg/m2후24~48 h 내상규진행심전도、이유초성심동도급3D-STI 감측。이 ROC 곡선하면적평개좌실정체면적응변(GAS)、정체종향응변(GLS)、정체경향응변(GRS)、정체원주응변(GCS)검측좌실공능조기손해준학성,병심조기검측민감성급특이성적절단치。21례녀성지원자작위대조조。결과GAS 화 GLS 재표유비성루계제량체240 mg/m2、360 mg/m2시교대조조、화료전명현감저(P <0.05),기중 GAS 적 ROC 곡선하면적위0.974,절단치위-31.5%,판단은배류약물대좌실공능손해적민감성위87.1%,특이성위92.9%。GAS 여표유비성루계제량지간현저상관(r =-0.834,P <0.01)。결론화료진정중 GAS 검측은배류약물심장독성적민감성、특이성교고,3D-STI 시검측은배류약물대유선암환자좌실심기공능조기손해적가고방법。
Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI)in early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving Anthracycline.Methods A group of 63 breast cancer postoperative patients were recruited and received a six-cycle epirubicin-based chemotherapy.Electrocardiogram,conventional echocardiography and 3D-STI parameters were measured before chemotherapy and during 24-48 hours after the cumulative dose of 120 mg/m2 ,240 mg/m2 and 360 mg/m2 .The receiver operating characteristics (ROC ) curves of 3D-STl parameters,such as global area strain(GAS),global longitudinal strain(GLS),global circumferential strain (GCS),and global radial strain(GRS)were drawn to determine optimal sensitivity and specificity.Twenty-one healthy female volunteers served as control subjects.Results Compared with before chemotherapy and control subjects,GAS and GLS were significantly reduced at the cumulative dose of 240 mg/m2 ,360 mg/m2 (P <0.05).The area under ROC of GAS was 0.974,and its optimal cut-off value was -3 1 .5%,with a specificity of 87.1 % and a sensitivity of 92.9%.Moreover,correlation analysis showed GAS was significantly associated with cumulative doxorubicin dose(r = -0.834,P < 0.01 ).Conclusions During chemotherapy,GAS can detect minor LV myocardial dysfunction associated with cardiotoxicity of anthracycline.3D-STI is useful in early dectection of left ventricular myocardial dysfunction in patients with breast cancer after receiving anthracycline.