本文選題：三維斑點追蹤成像技術 + 蒽環(huán)類藥物　； 參考：《石河子大學》2017年碩士論文

【摘要】：目的應用超聲三維斑點追蹤成像技術評價蒽環(huán)類藥物(anthracycline,ATC)化療前后乳腺癌患者的心室功能,并探究左室、右室整體應變參數(shù)監(jiān)測亞臨床心臟毒性的臨床價值。方法40例乳腺切除術后病理確診乳腺癌患者,均采用以表柔比星為主的AC-T化療方案(表柔比星+環(huán)磷酰胺,紫杉醇),且患者符合納入標準。應用自身對照研究,分別于化療前、化療2個周期后、化療4個周期后(24小時之內(nèi)),行常規(guī)超聲心動圖及采集三維心室全容積動態(tài)圖像,獲取參數(shù),并比較化療前后所有參數(shù)的變化。結果與化療前基礎狀態(tài)相比較,化療第2周期后、化療第4周期后左室的常規(guī)超聲參數(shù)LVESV、LVEDV、LVEF、LVFS、IVSd、LVPWd差異均無統(tǒng)計學意義(P0.05);同樣,與化療前相比較,右室的常規(guī)超聲參數(shù)RVD、TAPSE、S’、RVFAC差異均無統(tǒng)計學意義(P0.05)。化療后左室GAS和GLS較化療前明顯減低(P0.05),與蒽環(huán)類藥物累計劑量呈負向相關性,其中GAS的ROC曲線下面積為0.897,P=0.000,選-30.55%為診斷界點,靈敏度為0.857,特異度為0.917;化療后右室GLS、GCS、GRS均較化療前明顯減低(P0.05),并且右室GLS早于GCS、GRS,對右室GLS行Spearman相關分析,其相關系數(shù)r=-0.700,P=0.000,兩者呈顯著負相關。結論三維斑點追蹤技術可以早期發(fā)現(xiàn)蒽環(huán)類藥物致乳腺癌患者左、右室心肌功能的損害,早期評估其亞臨床心臟毒性,為臨床早期干預提供依據(jù)。
[Abstract]:Objective to evaluate the ventricular function of breast cancer patients before and after chemotherapy with anthracycline ATC by using three dimensional ultrasonic speckle tracing imaging, and to explore the clinical value of global strain parameters of left ventricle and right ventricle in monitoring subclinical cardiac toxicity.Methods 40 patients with breast cancer diagnosed by pathology after mastectomy were treated with epirubicin AC-T chemotherapy regimen (epirubicin cyclophosphamide, paclitaxel), and the patients met the inclusion criteria.In the autocontrol study, the parameters were obtained by routine echocardiography and 3D dynamic images of ventricular volume before chemotherapy, 2 cycles after chemotherapy, and within 24 hours after 4 cycles of chemotherapy.The changes of all parameters before and after chemotherapy were compared.Results compared with the baseline state before chemotherapy, there was no significant difference in LVESVV, LVEVDVV, LVFSV, IVSdT, LVPWd, LVESVV, LVEDVV, LVSdT and LVPWd between the two groups after the second cycle of chemotherapy and the fourth cycle of chemotherapy (P 0.05), and there was no significant difference in LVPWd between LVESVV and LVEDVV after the fourth cycle of chemotherapy.There was no significant difference in RVFAC between RVDX and TAPSES (P 0.05).After chemotherapy, GAS and GLS in the left ventricle decreased significantly compared with those before chemotherapy, and there was a negative correlation with the cumulative dose of anthracyclines. The area under the ROC curve of GAS was 0.897, and the diagnostic threshold was -30.55%.Conclusion Three-dimensional speckle tracing technique can detect the myocardial function damage of left and right ventricle in patients with breast cancer caused by anthracyclines, and evaluate its subclinical cardiac toxicity early, and provide evidence for early clinical intervention.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9;R540.45

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