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组织多普勒评价蒽环类和非蒽环类化疗药物对肿瘤病人左心室功能的治疗

【摘要】 目的 探讨组织多普勒技术(TDI)在评价蒽环类药物(ATC)对肿瘤病人左心室功能早期损害方面的临床应用价值。方法 50例肿瘤病人依据是否应用ATC化疗分为ATC化疗组(Ⅰ组)26例，非ATC化疗组(Ⅱ组)24例。测定并比较化疗前和化疗后6个月的常规超声心动图参数及组织多普勒参数。结果 组织多普勒显示化疗后Ⅰ、Ⅱ组二尖瓣瓣环之心室舒张早期运动速度峰值(Em)均较化疗前有明显降低(t=3.01、2.23，P<0.01、0.05)，心房收缩期运动速度峰值(Am)均较化疗前明显升高(t=2.96、2.16，P<0.01、0.05)，Em/Am均较化疗前明显降低(t=2.81、2.09，P<0.01、0.05);Ⅰ组收缩期运动速度峰值(Sm)较化疗前明显减低(t=2.43，P<0.05)，但Ⅱ组Sm化疗前后差异无显著性(t=2.00,P>0.05);化疗后Ⅰ组TDI参数值变化与Ⅱ组比较差异有显著性(t=2.03～2.08，P<0.05);但射血分数(EF)、短轴缩短率(FS)等常规左心室短轴收缩功能参数在化疗前后差异无显著性(t=1.99～2.03，P>0.05)，仅有13例(26%)病人出现常规左心室舒张功能指标异常。结论 TDI技术能更早、更敏感地评价ATC对肿瘤病人左心室功能损害。

【关键词】 超声心动描记术 多普勒 蒽环类 药物疗法 心室功能,左

[ABSTRACT]ObjectiveTo evaluate the clinical significance of tissue Doppler imaging (TDI) in assessing the damage of left ventricular function caused by cardiotoxic anthracycline chemotherapy in patients with malignancy.MethodsFifty patients with malignancy were divided into two groups: those treated with anthracycline as group Ⅰ; others treated with other chemotherapeutics as group Ⅱ. Echocardiography and TDI were performed both before chemotherapy and six months later after the treatment. ResultsTDI showed that the peak motion velocity of mitral annulus during early diastolic period (Em) decreased (t=3.01, 2.23;P<0.01, 0.05) and peak motion velocity during atria contraction period (Am) increased, both were significantly (t=2.96,2.16，P<0.01,0.05) after chemotherapy. The ratio of Em/Am decreased markedly (t=2.81,2.09;P<0.01,0.05) in both groups. The peak motion velocity of mitral annulus during systolic period (Sm) obviously decreased after chemotherapy in group Ⅰ (t=2.43，P<0.05), while no significant changes were noted in group Ⅱ (t=2.00, P>0.05). The parameters of TDI were significantly different between the two groups (t=2.03-2.08，P<0.05). Parameters of echocardiography showed that left ventricular short?axis systolic functions after chemotherapy were not significantly different as compared with the data acquired before the therapy (t=1.99-2.03，P>0.05). Abnormalities of routine diastolic function index of left ventricle appeared only in 13 patients (26%). ConclusionCompared with echocardiography, TDI can detect the abnormalities of left ventricular function of patients with malignancy earlier.

[KEY WORDS]echocardiography, Doppler; anthracyclines; drug therapy; ventricular function, left

蒽环类药物(ATC)是一类对造血系统和实体肿瘤具有高效作用的抗癌药物，但心脏毒性却限制了它的临床应用。国外有学者认为其心脏毒性对很多癌症病人预后的危害要比癌症复发更大[1]。目前用来评估ATC心脏毒性的手段有许多种,但对于其引起的亚临床型心脏毒性的早期检测尚无一致见解。组织多普勒技术是近年兴起的无创性定量评估局部心肌功能的新手段,较常规超声心动图更客观准确[2]。但在评价ATC致心脏损害方面的报道很少。本研究通过对50例肿瘤病人行化疗前和化疗后6个月常规超声心动图参数及组织多普勒参数的测定，探讨该技术在评价ATC致左心功能早期损害方面的临床应用价值。

1 资料与方法

1.1 对象

选择我院肿瘤科2005年8月～2006年6月住院的化疗病人68例，化疗前经临床和相关辅助检查排除冠心病、高血压、心肌病、瓣膜病、肺心病及心肌炎和糖尿病等疾病筛选出病人50例。其中非霍奇金淋巴瘤15例,乳癌12例,急性淋巴细胞性白血病10例,肺癌8例,胸腺瘤5例,均经手术或穿刺病理检查证实。上述病人依据是否应用ATC化疗分为两组：ATC化疗组(Ⅰ组)26例，男14例，女12例，年龄26～75岁,平均(56.5±2.8)岁;非ATC化疗组(Ⅱ组)24例，男13例，女11例，年龄23～78岁，平均(55.8±3.1)岁。两组间年龄、身高、体质量和心率均无显著性差异。Ⅰ组病人均采用以表阿霉素(EPI)为主的化疗方案。自首次使用EPI至检测,病程最短1个月,最长7年(平均412 d)。EPI累积剂量20～486 mg/m2,平均206.18 mg/m2。

1.2 方法