二维斑点追踪成像评估膀胱癌患者新辅助化疗致心脏毒性的应用价值

The Application Value of Two-Dimensional Speckle Tracking Imaging in Assessing Cardiotoxicity Induced by Neoadjuvant Chemotherapy in Bladder Cancer Patients

摘要: 目的：研究二维斑点追踪成像在浸润性膀胱癌患者新辅助化疗方案(吉西他滨 + 顺铂)后左室收缩功能早期受损的临床应用价值。方法：选取我院2023年6月至2024年12月期间诊断为浸润性膀胱癌患者31例(A组实验组)，其中男性23例，女性8例，平均年龄为62.65 ± 10.80岁，采用新辅助化疗(neoadjuvant chemotherapy, NAC) (顺铂 + 吉西他滨)联合根治性膀胱切除术(radical cystectomy, RC)化疗的治疗方案，以28天为一个周期，全部患者在用药前基线水平(T0)、第1周期(T1)、第2周期(T2)、第3周期(T3)结束后48 h内进行常规超声心动图检查及二维斑点追踪成像检查，获取IVSD、LVPWD、LVEDD、LVESD、LVEDV、LVESV、LVEF、LVFS、E、A、E/A、e'、E/e'、LVGLS。另选取非浸润性膀胱癌患者34例作为对照组(B组对照组)，并进行一次常规超声心动图检查及二维斑点追踪成像检查，获取与实验组同样数据。比较组间及组内数据的差异性。结果：与T0相比，T1、T2、T3时实验组患者IVSD、LVPWD、LVEDD、LVESD、LVEDV、LVESV均无显著差异(P > 0.05)；与T0相比，T1、T2、T3时实验组患者LVEF、LVFS差异无统计学意义(P > 0.05)；与T0相比，实验组患者LVGLS于T2、T3时出现降低，差异具有统计学意义(P < 0.05)；与T0相比，T1、T2、T3时实验组患者E、A、E/A、e'、E/e'无统计学差异(P > 0.05)，但E、e'随着用药次数的增加呈下降趋势。结论：膀胱癌新辅助化疗后常规超声检查结果在正常范围时，GLS可准确提供左室整体纵向应变的收缩功能参数变化，从而协助临床医生评价化疗后患者心脏早期受损情况。

Abstract: Objective: To investigate the clinical value of two-dimensional spot tracking imaging in the early impaired left ventricular systolic function after neoadjuvant chemotherapy (gemcitabine + cisplatin) in patients with invasive bladder cancer. How: Thirty-one patients (group A experimental group) diagnosed with invasive bladder cancer in our hospital from June 2023 to December 2024, including 23 males and 8 females, with an average age of 62.65 ± 10.80 years old, were selected for neoadjuvant chemotherapy, NAC (cisplatin + gemcitabine) combined with radical cystectomy (RC) chemotherapy, with a 28-day cycle. All patients underwent routine echocardiography and two-dimensional spot tracking imaging within 48 hours after the end of baseline (T0), cycle 1 (T1), cycle 2 (T2), and cycle 3 (T3) before medication. Obtain IVSD, LVPWD, LVEDD, LVESD, LVEDV, LVESV, LVEF, LVFS, E, A, E/A, e', E/e', and LVGLS. In addition, 34 patients with non-invasive bladder cancer were selected as the control group (group B control group), and routine echocardiography and two-dimensional spot tracking imaging were performed to obtain the same data as the experimental group. Compare data differences between and within groups. Results: Compared with T0, there were no significant differences in IVSD, LVPWD, LVEDD, LVESD, LVEDV and LVESV at T1, T2 and T3 (P > 0.05). Compared with T0, there was no significant difference in LVEF and LVFS at T1, T2 and T3 (P > 0.05). Compared with T0, LVGLS in the experimental group decreased at T2 and T3, and the difference was statistically significant (P < 0.05). Compared with T0, there was no significant difference in E, A, E/A, e' and E/e' in the experimental group at T1, T2 and T3 (P > 0.05), but E' and e' showed a decreasing trend with the increase of the number of administration. Conclusion: When the results of routine ultrasound examination after neoadjuvant chemotherapy for bladder cancer are in the normal range, GLS can accurately provide the change of systolic function parameters of the global longitudinal strain of the left ventricle, so as to assist clinicians in evaluating the early cardiac damage after chemotherapy.