3D-STI联合心脏综合指数评价肺癌患者GP化疗方案的隐匿性心肌毒性(1)
摘要：目的 利用三维斑点追踪成像(3D-STI)技术获得左室应变参数及扭转角度，计算心肌综合指数(MCI)，评估其对非小细胞肺癌(NSCLC)患者吉西他滨联合顺铂(GP)化疗方案隐匿性心肌毒性的诊断价值。方法 选取我院2017年3月～2018年6月采取GP化疗方案的46例NSCLC患者作为化疗组，选取同期30例健康志愿者作为对照组。记录两组化疗开始前基础状态时(T1)、第3次化疗结束后(T2)和第6次化疗结束后(T3)的三维参数和常规超声心动图参数，比较两组左室心肌整体圆周应变(GCS)、整体径向应变(GRS)、整体纵向应变(GLS)、左室收缩期心肌扭转角度(LVtw)、心肌综合指数(MCI)以及常规超声心动图参数的改变;制作ROC曲线，分析评价心肌损害的最准确、最敏感的指标，并评估其在检测NSCLC化疗患者隐匿性心肌毒性中的价值。结果 ①化疗组T1时应变参数GRS、GCS、GLS、LVtw及MCI结果与对照组比较，差异无统计学意义(P>0.05);化疗组T2时GRS、GCS结果与T1时及对照组比较，差异无统计学意义(P>0.05)，MCI、LVtw、GLS结果低于T1时及对照组，差异有统计学意义(P<0.05);化疗组T3时GRS、GCS、GLS、LVtw及MCI结果均低于T1时及对照组，差异有统计学意义(P<0.05);②MCI、LVtw及GLS的AUC均>0.7，其中MCI的AUC最大，为0.836。以-240.50为截断值时，MCI诊断GP化疗方案对NSCLC患者左室心肌的隐匿性毒性的灵敏度为91.30%，特异度為72.13%;以-19.50为截断值时，GLS诊断的特异度为81.77%，灵敏度为52.17%;截断值为13.15时，LVtw的灵敏度为69.57%，特异度为68.03%。结论 3D-STI技术结合MCI对化疗引起的隐匿性心脏毒性的早期诊断具有独特的优势。ROC曲线分析提示MCI较其他应变参数评价隐匿性心脏毒性更敏感，可早期检测出GP化疗方案对NSCLC患者心脏的隐匿性毒性损害，具有较高的临床参考价值。
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关键词：三维斑点追踪成像;心肌综合指数;非小细胞肺癌;心脏毒性;吉西他滨;顺铂
中图分类号：R734.2;R540.45 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.08.029
文章编号：1006-1959(2019)08-0100-05
Abstract：Objective To obtain left ventricular strain parameters and torsion angles using three-dimensional speckle tracking imaging (3D-STI) technique， and to calculate myocardial comprehensive index (MCI) for gemcitabine plus cisplatin (GP) chemotherapy in patients with non-small cell lung cancer (NSCLC). The diagnostic value of occult myocardial toxicity.Methods 46 patients with NSCLC who underwent GP chemotherapy from March 2017 to June 2018 were enrolled as the chemotherapy group. 30 healthy volunteers were selected as the control group. Three-dimensional parameters and conventional echocardiographic parameters of the left ventricular myocardium were compared between the two groups before the start of chemotherapy (T1)， after the third chemotherapy (T2)， and after the sixth chemotherapy (T3). Strain (GCS)， global radial strain (GRS)， global longitudinal strain (GLS)， left ventricular systolic myocardial torsion angle (LVtw)， myocardial composite index (MCI)， and changes in conventional echocardiographic parameters; Analyze and evaluate the most accurate and sensitive indicators of myocardial damage and evaluate its value in detecting occult myocardial toxicity in patients with NSCLC chemotherapy.Results ①There was no significant difference in GRS，GCS，GLS，LVtw and MCI between the chemotherapy group and the control group at T1 (P>0.05). There was no significant difference in GRS，GCS at T2 between chemotherapy group and T1 and control group (P>0.05)，The results of MCI， LVtw and GLS were lower than T1 and the control group， the difference was statistically significant (P<0.05). The results of GRS， GCS， GLS， LVtw and MCI in T3 were lower than those in T1 and the control group，the difference was statistically significant (P<0.05); ②the AUC of MCI， LVtw and GLS were all >0.7， and the AUC of MCI was the largest， 0.836. When the cutoff value was -240.50， the sensitivity of MCI diagnosis of GP chemotherapy to occult toxicity of left ventricular myocardium in patients with NSCLC was 91.30%， and the specificity was 72.13%. When the cutoff value was -19.50， the specificity of GLS diagnosis was 81.77%， the sensitivity is 52.17%; when the cutoff value is 13.15， the sensitivity of LVtw is 69.57%， and the specificity is 68.03%.Conclusion 3D-STI technology combined with MCI has a unique advantage in the early diagnosis of occult cardiotoxicity induced by chemotherapy. ROC curve analysis indicated that MCI was more sensitive than other strain parameters in evaluating occult cardiotoxicity， and early detection of occult toxicity of GP chemotherapy in patients with NSCLC had a high clinical reference value., 百拇医药(刘贝 郑慧 周旺 许芳芳 张金鑫)
, http://www.100md.com
关键词：三维斑点追踪成像;心肌综合指数;非小细胞肺癌;心脏毒性;吉西他滨;顺铂
中图分类号：R734.2;R540.45 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.08.029
文章编号：1006-1959(2019)08-0100-05
Abstract：Objective To obtain left ventricular strain parameters and torsion angles using three-dimensional speckle tracking imaging (3D-STI) technique， and to calculate myocardial comprehensive index (MCI) for gemcitabine plus cisplatin (GP) chemotherapy in patients with non-small cell lung cancer (NSCLC). The diagnostic value of occult myocardial toxicity.Methods 46 patients with NSCLC who underwent GP chemotherapy from March 2017 to June 2018 were enrolled as the chemotherapy group. 30 healthy volunteers were selected as the control group. Three-dimensional parameters and conventional echocardiographic parameters of the left ventricular myocardium were compared between the two groups before the start of chemotherapy (T1)， after the third chemotherapy (T2)， and after the sixth chemotherapy (T3). Strain (GCS)， global radial strain (GRS)， global longitudinal strain (GLS)， left ventricular systolic myocardial torsion angle (LVtw)， myocardial composite index (MCI)， and changes in conventional echocardiographic parameters; Analyze and evaluate the most accurate and sensitive indicators of myocardial damage and evaluate its value in detecting occult myocardial toxicity in patients with NSCLC chemotherapy.Results ①There was no significant difference in GRS，GCS，GLS，LVtw and MCI between the chemotherapy group and the control group at T1 (P>0.05). There was no significant difference in GRS，GCS at T2 between chemotherapy group and T1 and control group (P>0.05)，The results of MCI， LVtw and GLS were lower than T1 and the control group， the difference was statistically significant (P<0.05). The results of GRS， GCS， GLS， LVtw and MCI in T3 were lower than those in T1 and the control group，the difference was statistically significant (P<0.05); ②the AUC of MCI， LVtw and GLS were all >0.7， and the AUC of MCI was the largest， 0.836. When the cutoff value was -240.50， the sensitivity of MCI diagnosis of GP chemotherapy to occult toxicity of left ventricular myocardium in patients with NSCLC was 91.30%， and the specificity was 72.13%. When the cutoff value was -19.50， the specificity of GLS diagnosis was 81.77%， the sensitivity is 52.17%; when the cutoff value is 13.15， the sensitivity of LVtw is 69.57%， and the specificity is 68.03%.Conclusion 3D-STI technology combined with MCI has a unique advantage in the early diagnosis of occult cardiotoxicity induced by chemotherapy. ROC curve analysis indicated that MCI was more sensitive than other strain parameters in evaluating occult cardiotoxicity， and early detection of occult toxicity of GP chemotherapy in patients with NSCLC had a high clinical reference value., 百拇医药(刘贝 郑慧 周旺 许芳芳 张金鑫)