2026 年第 8 期 第 21 卷

超声心动图斑点追踪技术在乳腺癌患者蒽环类药物所致心脏毒性早期评估中的应用

Application of echocardiographic speckle tracking imaging in early evaluation of anthracycline-induced cardiotoxicity in breast cancer patients

作者：孙运峰唐莎

英文作者：Sun Yunfeng Tang Sha

单位：新疆医科大学第四附属医院新疆维吾尔自治区中医医院心脏超声科，乌鲁木齐830000

英文单位：Department of Cardiac Ultrasound the Fourth Affiliated Hospital of Xinjiang Medical University Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region Urumqi 830000 China

关键词：乳腺癌；超声心动图斑点追踪技术；蒽环类药物；心脏毒性

英文关键词：Breastcancer;Echocardiographicspeckletrackingimaging;Anthracyclines;Cardiotoxicity

• 摘要：

• 目的 探讨超声心动图斑点追踪技术（STI）在乳腺癌患者蒽环类药物所致心脏毒性早期评估中的应用价值。方法 选取新疆维吾尔自治区中医医院2022年1月至2024年6月接受蒽环类药物治疗的乳腺癌患者137例，于化疗前、化疗3个周期、化疗6个周期进行STI检查与常规超声检查，并随访12个月，观察心脏毒性发生情况并分组。比较2组不同时点STI参数与左心室射血分数（LVEF），采用Pearson检验分析STI参数与LVEF的相关性，采用Cox回归分析乳腺癌患者蒽环类药物所致心脏毒性的影响因素，采用限制性立方样条（RCS）模型分析STI参数与乳腺癌患者蒽环类药物所致心脏毒性的剂量-反应关系。结果 137例乳腺癌患者中，最终132例患者完成研究。26例发生心脏毒性纳入心脏毒性组，其余106例纳入非心脏毒性组。心脏毒性组年龄、高血压病比例、蒽环类药物累积剂量均高于非心脏毒性组（均P＜0.05）。化疗3、6个周期，心脏毒性组纵向应变、圆周应变、径向应变绝对水平均低于化疗前，且均低于非心脏毒性组（均P＜0.05）。心脏毒性组化疗前后纵向应变差值、圆周应变差值、径向应变差值水平均高于非心脏毒性组［（4.28±2.47）比（0.67±0.22）、（5.08±2.70）比（0.66±0.18）、（9.07±4.55）比（1.83±0.55）］（均P＜0.001）。Pearson相关性分析结果显示，各时点STI参数纵向应变、圆周应变、径向应变与LVEF水平均呈正相关（均P＜0.05）。Cox回归分析结果显示高血压病、化疗前后纵向应变差值、化疗前后圆周应变差值、化疗前后径向应变差值均为乳腺癌患者蒽环类药物所致心脏毒性的影响因素（均P＜0.05）。RCS分析结果显示，化疗前后纵向应变差值、化疗前后圆周应变差值、化疗前后径向应变差值均与乳腺癌患者蒽环类药物所致心脏毒性呈非线性剂量-反应关系（均P＜0.001）。结论 乳腺癌患者化疗前后STI参数纵向应变差值、圆周应变差值、径向应变差值均为蒽环类药物所致心脏毒性的影响因素，动态监测STI参数可有效识别心脏毒性高风险患者，可为调整治疗方案、早期实施干预措施提供参考。

• Objective To explore the application value of echocardiographic speckle tracking imaging (STI) in the early evaluation of anthracycline-induced cardiotoxicity in breast cancer patients. Methods A total of 137 breast cancer patients treated with anthracyclines in Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2022 to June 2024 were enrolled. STI and conventional ultrasonography were performed before chemotherapy, after 3 chemotherapy cycles and 6 chemotherapy cycles respectively, and all patients were followed up for 12 months. Patients were grouped according to the occurrence of cardiotoxicity. STI parameters and left ventricular ejection fraction (LVEF) at different time points were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between STI parameters and LVEF. Cox regression analysis was adopted to explore the influencing factors of anthracycline-induced cardiotoxicity, and restricted cubic spline (RCS) model was used to analyze the dose-response relationship between STI parameters and anthracycline-induced cardiotoxicity. Results Among the 137 breast cancer patients, 132 finally completed the study. Twenty-six patients with cardiotoxicity were assigned to the cardiotoxicity group, and the remaining 106 cases to the non-cardiotoxicity group. The age, proportion of hypertension and cumulative anthracycline dose in the cardiotoxicity group were higher than those in the non-cardiotoxicity group (all P＜0.05). At 3 and 6 cycles of chemotherapy, the absolute levels of longitudinal strain, circumferential strain and radial strain in the cardiotoxicity group were lower than those before chemotherapy and also lower than those in the non-cardiotoxicity group (all P＜0.05). The differences of longitudinal strain, circumferential strain and radial strain before and after chemotherapy in the cardiotoxicity group were higher than those in the non-cardiotoxicity group ［(4.28±2.47) vs (0.67±0.22), (5.08±2.70) vs (0.66±0.18), (9.07±4.55) vs (1.83±0.55)］(all P<0.001). Pearson correlation analysis showed that STI parameters including longitudinal strain, circumferential strain and radial strain at each time point were positively correlated with LVEF (all P＜0.05). Cox regression analysis indicated that hypertension, as well as the differences of longitudinal strain, circumferential strain and radial strain before and after chemotherapy were influencing factors of anthracycline-induced cardiotoxicity in breast cancer patients (all P＜0.05). RCS analysis showed that the differences of longitudinal strain, circumferential strain and radial strain before and after chemotherapy presented a nonlinear dose-response relationship with anthracycline-induced cardiotoxicity (all P＜0.001). Conclusion The differences of longitudinal strain, circumferential strain and radial strain detected by STI before and after chemotherapy are influencing factors of anthracycline-induced cardiotoxicity in breast cancer patients. Dynamic monitoring of STI parameters can effectively identify high-risk patients with cardiotoxicity and provide reference for adjusting treatment regimens and implementing early intervention measures.