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目的探讨利用组织多普勒定量组织速度成像QTVI技术对蒽环类药物早期心脏毒性进行评估。方法 30例在江北人民医院化疗的肿瘤患者,所用化疗方案以表阿霉素(Epi)为主,表阿霉素总累计量(450±75)mg/m2,每个疗程治疗前进行组织多普勒定量组织速度成像和常规超声心动图检查。同时设健康对照组20例。常规超声心动图指标包括左室舒张末内径(LVDd),左室收缩末内径(LVDs),左室射血分数(LVEF),室间隔与左室后壁厚度(IVSTd、LVP-WTd),二尖瓣口血流速度(早期速度E、晚期速度A及两者比值E/A);定量组织速度成像测量二尖瓣环上左室侧壁及后间隔两个位点的峰值速度(收缩期峰值Vs、收缩期加速度a,舒张期峰值Ve)。结果与第一次治疗前对比,常规超声指标LVDd、LVDsI、VSTd、LVPWTd差别无统计学意义(P>0.05),左室射血分数在累积量达到450 mg/m2时差别有统计学意义(50.1±7.3与68.0±9.0,P<0.05)。舒张期指标E/A在累积量达到375 mg/m2时差别有统计学意义(0.71±0.14与1.20±0.21,P<0.05)。利用组织多普勒QTVI技术检测对比发现,收缩期指标Vs、a在累积量达300 mg/m2时差别有统计学意义([5.70±1.07)cm/s与(7.84±1.10)cm/s(、132±14)cm/s2与(219±31)cm/s2,P<0.05],舒张期指标Ve在累积量达到225 mg/m2差别有统计学意义([6.86±1.04)cm/s与(8.74±1.32)cm/s,P<0.05]。结论在监测表阿霉素心脏毒性上,组织多普勒超声心动图较常规超声心动图能较早期和较敏感发现心脏损害,且舒张功能的损害早于收缩功能。
Objective To evaluate the early cardiotoxicity of anthracyclines using tissue Doppler tissue velocity imaging (QTVI). Methods Thirty patients with chemotherapy in Jiangbei People’s Hospital were treated with epirubicin (Epi). The total cumulative dose of epirubicin (450 ± 75) mg / m2 was Doppler quantitative tissue velocity imaging and conventional echocardiography. At the same time set 20 cases of healthy control group. Conventional echocardiographic parameters include left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left ventricular ejection fraction (LVEF), ventricular septum and left ventricular posterior wall thickness (IVSTd, LVP-WTd) The velocity of mitral orifice blood flow (early velocity E, late velocity A and the ratio E / A of both); quantitative tissue velocity imaging measured the peak velocities of the two sites on the left ventricular wall and the posterior septum on mitral annulus Peak Vs, systolic acceleration a, diastolic peak Ve). Results Compared with those before the first treatment, the differences of LVDd, LVDsI, VSTd and LVPWTd were not statistically significant (P> 0.05), and the difference of LVEF was 450 mg / m2 50.1 ± 7.3 and 68.0 ± 9.0, P <0.05). Diastolic index E / A was statistically different when the cumulant reached 375 mg / m2 (0.71 ± 0.14 vs. 1.20 ± 0.21, P <0.05). Contrasting with tissue Doppler QTVI technique, it was found that the systolic index Vs, a had a significant difference ([5.70 ± 1.07] cm / s and (7.84 ± 1.10) cm / s , 132 ± 14 cm / s2 and (219 ± 31) cm / s2, P <0.05]. The mean value of diastolic index Ve was 225 mg / m2 (8.74 ± 1.32) cm / s, P <0.05]. Conclusion In monitoring epirubicin cardiotoxicity, tissue Doppler echocardiography can detect heart damage earlier and more sensitive than conventional echocardiography, and diastolic function is earlier than contractile function.