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目的探讨应用二维斑点追踪成像技术监测柔红霉素化疗对急性淋巴细胞白血病(急淋)患儿左心室短轴心肌扭转功能的影响,分析心脏功能损伤与柔红霉素不同累积剂量的关系。方法研究对象为2007年1月至2009年12月深圳市儿童医院诊断的急淋患儿60例,均接受柔红霉素化疗,按治疗程序分为A组(化疗前)、B组(柔红霉素化疗累积剂量达120mg/m2)和C组(柔红霉素化疗累积剂量达240mg/m2)。对照组为同期体检正常儿童60名。检测每组常规超声心动图指标左室射血分数(EF)、二尖瓣口舒张期血流比值(E/A),并应用超声二维斑点追踪成像技术(two-dimensional speckle tracking imaging,2DSI)检测对照组及A、B、C组的左室短轴基底段和心尖段的心肌节段收缩期峰值旋转度,计算左室心肌收缩期峰值扭转角度。结果心率、EF、二尖瓣口舒张期E/A比值在对照组、A、B、C各组间比较,差别无统计学意义(P>0.05)。A、B组与对照组比较,基底段和心尖段的峰值旋转角度差异无统计学意义(P>0.05);C组与对照组比较心尖段峰值旋转角度,差异无统计学意义(P>0.05);C组与对照组、A组、B组比较,基底段峰值旋转角度差异有统计学意义(F=5.23,P<0.05)。A、B组与对照组比较,左室扭转角度差异无统计学意义(P>0.05),但C组小于对照组、A组、B组,差异有统计学意义(F=4.51,P<0.05)。结论急淋患儿柔红霉素化疗累积剂量达120mg/m2时未发现心脏扭转功能损伤,当达到240mg/m2时,心脏扭转功能出现显著损伤,2DSI可无创性定量监测患儿心脏功能的变化,对临床评价柔红霉素的心脏毒性、预防化疗后遗症的发生有重要意义。
Objective To investigate the effect of daunorubicin chemotherapy on torsion of left ventricular (LV) myocardium in children with acute lymphoblastic leukemia (AML) by two-dimensional speckle tracking imaging and to analyze the relationship between cardiac dysfunction and different cumulative doses of daunorubicin relationship. Methods Subjects were 60 cases of acute lymphocytosis diagnosed by Shenzhen Children’s Hospital from January 2007 to December 2009, all undergoing daunorubicin chemotherapy. Patients were divided into group A (before chemotherapy), group B Erythromycin chemotherapy cumulative dose of 120mg / m2) and C group (daunorubicin chemotherapy cumulative dose of 240mg / m2). Control group for the same period the physical examination of 60 normal children. The left ventricular ejection fraction (EF) and mitral diastolic flow rate (E / A) of each echocardiographic group were measured. Two-dimensional speckle tracking imaging (2DSI ) To detect the peak systolic rotation of the myocardial segments of the left ventricular short axis and the basal segments of the A, B and C groups, and calculate the peak twist angle of left ventricular systolic. Results There was no significant difference in heart rate, EF and mitral E / A ratio between control group, A, B and C groups (P> 0.05). There was no significant difference in peak rotation angle between basal segment and apical segment in group A and group B (P> 0.05). Compared with control group, there was no significant difference in peak rotation angle between group C and control group (P> 0.05 ). Compared with control group, group A and group B, the peak rotation angle of basement segment in group C was statistically significant (F = 5.23, P <0.05). There was no significant difference in left ventricular torsion angle between group A and group B (P> 0.05), but the difference between group C and group B was less than that of control group, group A and group B (F = 4.51, P <0.05) ). Conclusion The cumulative dose of daunorubicin chemotherapy in patients with acute lymphocytic leiomycin did not show any cardiac torsion dysfunction when the cumulative dose of daunorubicin chemotherapy reached 120mg / m2. The cardiac torsion function was significantly impaired when it reached 240mg / m2, and 2DSI could noninvasively and quantitatively monitor the cardiac function in children , The clinical evaluation of daunorubicin cardiotoxicity, prevention of chemotherapy sequelae is of great significance.