蒽环类药物心脏毒性早期监测方法的评价

Evaluation of early monitoring of cardiotoxicity induced by anthracyclines

摘要:

目的：蒽环类药物（ANT）对白血病、实体瘤疗效显著,但因其心脏毒性，严重影响患儿远期生活质量。本研究旨在评价二维超声（2DE）和血清生化指标早期监测ANT心脏毒性的价值。方法：70例接受ANT化疗患儿（ANT剂量124±73 mg/m2，随访22±13月）进行2DE检测，包括常规指标（左室内径及室壁厚度、射血分数、E/A等）、心肌工作指数（MPI）、组织多普勒（TDI）, 并采血检测血清肌钙蛋白(CTnI)、脑利钠肽(BNP)含量。37例健康体检儿为对照组。结果：病例组2DE常规指标与对照组比较差异无统计学意义。与对照组比较，病例组左、右室MPI明显增大（0.237±0.06、0.171±0.05 vs 0.203±0.06、0.140±0.04，P<0.01），TDI示病例组左室侧基底段、中间段舒张晚期组织运动峰值速度（Am），室间隔侧基底段、中间段Am，右室侧基底段、中间段Am均较对照组明显增高；左室侧中间段舒张早期组织运动峰值速度（Em）/Am，室间隔侧基底段、中间段Em/Am差异有统计学意义（P<0.05）。且随着ANT累积剂量增加，MPI和TDI变化更加明显。血清CTnI、BNP水平与对照组比较差异无统计学意义。结论：接受ANT治疗者需长期监测心功能；MPI、TDI能早期反映ANT对患者心功能的影响。

Abstract:

OBJECTIVE: Anthracyclines (ANT) are effective for leukemia and solid tumors. However the long-term life quality of patients is seriously affected by ANT-related cardiotoxicity. The aim of this study was to evaluate the value of two dimension echocardiography (2DE) and serum biochemical indicators in monitoring ANT-related cardiotoxicity. METHODS: Seventy children who received ANT chemotherapy (ANT dose: 124±73 mg/m2) and were followed up for 22±13 months were enrolled. 2DE with aspects of conventional indexes (left ventricular diameter and wall thickness, ejection fraction, E/A), myocardial performance index (MPI) and tissue Doppler imaging (TDI) were performed. Serum levels of troponin (CTnI) and brain natriuretic peptide (BNP) were measured. Thirty-seven healthy children served as the control group. RESULTS: There were no significant differences in conventional indexes of 2DE between the ANT and the control groups. The MPI of left and right ventricular in the ANT group increased significantly compared with that in the control group (0.237±0.06 vs 0.203±0.06, 0.171±0.05 vs 0.140±0.04 respectively; P<0.01). TDI showed the late diastolic peak velocity in the basal and middle sections of left ventricular, interventricular septum and right ventricular in the ANT group were significantly higher than the controls. There were significant differences in the ratio of early to late diastolic peak velocity of the middle section of left ventricular and the basal and middle sections of the interventricular septum between the two groups (P<0.05). The changes of MPI and TDI became more obvious with the increased dose of ANT. There were no significant differences in serum CtnI and BNP levels between the two groups. CONCLUSIONS: The heart function of patients who received ANT chemotherapy needs to be monitored for a long term. MPI and TDI can be used as early indexes for monitoring the heart function.