刘俊峰 刘伟亮 陆海永 陈云璇 温德惠 王义成 郜新春

[摘要] 目的 探讨应变率显像技术对蒽环类化疗药物致乳腺癌患者右心室功能影响的评价作用。 方法 选取2015年10月～2016年10月在河北北方学院附属第一医院经病理确诊、采用CAF化疗方案的80例女性乳腺癌患者。所有研究对象采取自身对照的方式，分别于化疗前1 d及每次化疗周期的第5天获取常规超声心动图参数及应变率数据。 结果 在第6个化疗周期后，受试者的三尖瓣瓣环收缩期位移低于化疗前，右心室心肌功能指数高于化疗前（P < 0.05）。应变/应变率显像发现，与治疗前相比，乳腺癌患者蒽环类药物化疗第6周期后整体径向应变、整体长轴应变率及整体圆周应变显著下降（P < 0.05）。 结论 应变率成像能够早期反映蒽环类药物致乳腺癌患者右心室功能的改变。

[关键词] 应变率成像；蒽环类药物；乳腺癌；右心室功能

[中图分类号] R445.1 [文献标识码] A [文章编号] 1673-7210（2018）08（b）-0084-04

[Abstract] Objective To investigate the value of strain rate imaging for assessing the effect of anthracycline on right ventricular function in women with breast cancer. Methods From October 2015 to October 2016， 80 women pathologically diagnosed as breast cancer and undergoing CAF chemotherapy protocol at the First Affiliated Hospital of Hebei North University were recruited in this study. By the way of self-control， conventional echocardiography and strain rate imaging were performed to assess the right ventricular function at the first day before starting chemotherapy and the fifth day of every 5 chemotherapy cycles. Results The tricuspid annular plane systolic excursion was significantly lower， while the right ventricular myocardial performance index was significantly higher in women after the sixth cycles of chemotherapy compared with those before chemotherapy （P < 0.05）. Strain rate imaging showed that global longitudinal strain rate， global radial strain and global circumferential strain in women after the sixth cycle of chemotherapy were significantly lower than those before chemotherapy（P < 0.05）. Conclusion Strain rate imaging can reflect the change of right ventricular function at an early stage in breast cancer women treated with anthracycline.

[Key words] Strain rate imaging； Anthracycline； Breast cancer； Right ventricular function

蒽環类药物（anthracycline，ATC）是一种高效广谱抗癌药物，包括阿霉素、表阿霉素、柔红霉素和阿克拉霉素等，其广泛应用于血液系统恶性肿瘤及实体肿瘤，如乳腺癌的化学治疗。蒽环类药物的抗瘤作用强，疗效确切，但可引起脱发等一系列毒副作用，对心脏的整体毒性尤甚[1]。目前国内外主要研究方向为蒽环类药物化疗后对左心室的不良反应及毒性作用。近年来，右心室功能在临床地位不断提升，蒽环类药物对右心室功能的影响也逐渐引起重视；然而右心室解剖结构不对称、不规则的特殊性使其功能检测成为临床难点之一。局部心肌的变形称为应变，单位时间内心肌的应变称为应变率，应变率反映的是心肌变形的速度[2]。应变率成像（strain and strain rate imaging，S/SR）是在多普勒基础上发展而来、从时间和空间反映心肌纤维应变的程度及定量评价室壁运动功能的技术[3-4]。……