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重庆市中医院
纸质出版日期:2023,
网络出版日期:2023-8-30,
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邹文娟, 封雪, 宋娜, 等. 左心室压力-应变环技术评估结直肠癌患者贝伐珠单抗联合化疗早期心功能损害[J]. 临床超声医学杂志, 2023,25(8).
3D-STI to assess subclinical cardiac impairment in colorectal cancer with bevacizumab in combination with chemotherapy[J]. Journal of Clinical Ultrasound in Medicine, 2023,25(8).
目的 探讨三维斑点追踪成像技术(3D-STI)评估结直肠癌使用贝伐单抗联合化疗所致亚临床心功能损伤的价值。方法 选取使用贝伐单抗+FOLFOX抗肿瘤治疗的晚期结直肠癌患者50例为观察组
50例健康自愿者作为对照组。均在治疗前、治疗第2周期前、治疗第4周期前、治疗第6周期前1天及治疗结束后3个月分别进行超声心动图及3d- STI技术检查。二维超声模式下记录左房前后径(LA)、右房左右径(RA)、左室舒张末内径(LVEDs)、收缩末内径(LVEDd)、等容舒张时间(IVRT)、二尖瓣口舒张早期和晚期峰值流速(E和A)、二尖瓣E峰减速时间(EDT)、二尖瓣环舒张早期峰值速度 (e");3D-STI采用EchoPAC 110定量软件分析左室射血分数(LVEF)、整体纵向应变 (GLS)、纵向应变达峰时间离散度 (PSD)、左室心肌整体做功指数(GWI)、整体做功效率(GWE)、整体有用功(GCW)、整体无用功 (GWW)
软件自动得出应变牛眼图及压力-应变环。结果 观察组与对照组比较
用药6周期后LVEF减小
E/e增加
差异有显著性(均P<0.05);病例组用药6周期后与用药前比较
仅E/e治疗6周期组增加差异有显著性(均P<0.05)。同时用药4周期时 GLS、GWI、GWE均减小
PSD增大(均P<0.05)
用药6周期时 GLS、GCS、GWI、GWE均减小
PSD、GWW增大(均P<0.05)。与用药前比较
用药6周期时 GLS、GWI、GWE均减小
PSD增大(均P<0.05)。结论 贝伐单抗联合化疗6周期后
患者左室收缩和舒张功能均有影响
且舒张功能下降更为敏感
亦可能早于收缩功能受损。同时压力-应变环的多项参数能敏感、有效地评估贝伐单抗联合化疗患者左室收缩功能
为患者病情严重程度的评估提供新的客观的量化指标。
Objective To explore the value of three-dimensional spot tracking imaging (3D-STI) in evaluating bevacizumab in combination with chemotherapy in the treatment of subclinical cardiac injury caused by colorectal cancer.Method Fifty patients with advanced colorectal cancer treated with bevacizumab + FOLFOX anti-tumor therapy were selected as the observation group
and 50 healthy volunteers were selected as the control group. Echocardiography and 3D-STI techniques were performed before treatment
before the second cycle of treatment
before the 4th cycle
1 day before the 6th cycle of treatment
and 3 months after the end of treatment. The left atrial anteroposterior diameter (LA)
right atrial left and right diameter (RA)
left ventricular end-diastolic inner diameter (LVEDs)
end-systolic inner diameter (LVEDd)
isovolemic diastolic time (IVRT)
early and late mitral orifice diastolic peak flow rates (E and A)
mitral valve E peak deceleration time (EDT)
and early mitral annular diastolic peak velocity (e") were recorded in two-dimensional ultrasound mode. 3D-STI used EchoPAC 110 quantitative software to analyze left ventricular ejection fraction (LVEF)
global longitudinal strain (GLS)
longitudinal strain peak time dispersion (PSD)
left ventricular myocardial overall work index (GWI)
overall power rate (GWE)
overall useful work (GCW)
and overall no work ( GWW)
the software automatically derives the strain bull"s eye diagram and the pressure-strain ring. Results Compared with the control group
LVEF decreased and E/e increased after 6 cycles of medication in the observation group (all P<0.05). Compared with the 6-cycle treatment group of the case group after 6 cycles and before medication
only the increase in the E/e treatment 6-cycle group was significant (all (all P<0.05). At the same time for 4 cycles
GLS
GWI and GWE decreased
P SD increased (all P<0.05)
and 6 were used GLS
GCS
GWI and GWE decreased during the cycle
and P SD and GWW increased (all P<0.05). Compared with before medication
GLS
GWI and GWE decreased after 6 cycles
and P SD increased (all P<0.05) 。Conclusion After 6 cycles of bevacizumab combined with chemotherapy
both left ventricular systolic and diastolic function are affected
and diastolic function decline is more sensitive
which may also be earlier than systolic function impaired. At the same time
multiple parameters of pressure-strain ring can sensitively and effectively evaluate the left ventricular systolic function of patients with bevacizumab combined with chemotherapy
and provide a new objective quantitative index for the assessment of the severity of the patient"s condition.
晚期结直肠癌,贝伐单抗,3D-STI,心功能损伤
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