摘要目的 探讨放射性核素平衡法心血池显像对乳腺癌靶向治疗中左心室功能变化的评估作用.方法 前瞻性观察2016年2月至2017年12月期间60例女性乳腺癌患者[年龄28～65(48.7±9.4)岁]靶向治疗前后心血池显像结果.根据不同治疗方案将患者分为A组[(紫杉醇注射液(泰素)联合拉帕替尼)]25例[年龄29～65(47.8±11.3)岁]、B组(拉帕替尼)35例[年龄31～62(51.1±8.5)岁].患者分别在治疗前1个月、治疗6及12个月后进行心血池显像.观察左心室功能指标,包括左心室射血分数(LVEF)、1/3射血分数(EF)、高峰射血率(PER)、高峰射血率时间(TPER)、1/3充盈分数(FF)、高峰充盈率(PFR)及高峰充盈率时间(TPFR).采用重复测量方差分析、两独立样本t检验和Wilcoxon秩和检验分析数据.结果 A组治疗前的PER为(3.60±0.62)舒张末期容积(EDV)/s,治疗6个月后PER与其差异无统计学意义[(3.34±0.57)EDV/s;F=3.447,t=0.51,P>0.05],治疗12个月后PER与其差异有统计学意义[(3.11±0.48)EDV/s;t=0.60,P<0.05];A组治疗前、治疗6和12个月后的PFR分别为(3.57±0.81)、(3.07±0.71)和(2.84±0.54)EDV/s,与治疗前比,治疗6和12个月后的PFR差异均有统计学意义(F=5.345,t=0.82和0.75,均P<0.05).B组治疗前PFR为(3.23±0.87)EDV/s,治疗12个月后PFR为(2.86±0.55)EDV/s,与治疗前相比降低有统计学意义(F=3.214,t=0.84,P<0.05).A组治疗6与12个月的PFR下降程度[-0.37(-0.78,0.15)EDV/s]大于B组对应时间PFR的下降程度[-0.13(-0.44,0.17)EDV/s;z=-1.569,P<0.05].结论 核素心血池显像能够有效监测乳腺癌患者靶向治疗后左心室功能的变化,PER和PFR较其他参数能更灵敏地反映心功能变化,联合用药对心功能的影响比应用拉帕替尼单药出现更早.

abstractsObjective To observe the evaluation function of gated equilibration ventriculography for the changes of left ventricular function in breast cancer with targeted therapy. Methods From February 2016 to December 2017, a total of 60 female breast cancer patients (age:28-65 (48.7±9.4) years) were included prospectively. Patients were divided into 2 groups: lapatinib combined with taxeme-based chemo-therapy group (group A;n=25, age:29-65 (47.8±11.3) years) and lapatinib monotherapy group (group B;n=35, age:31-62 (51.1±8.5) years). All patients underwent gated equilibration ventriculography be-fore treatment and 6/12 months after treatment. The parameters of left ventricular function including left ven-tricle ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR), 1/3 ejection fraction (EF), 1/3 filling fraction (FF), time to peak ejection rate (TPER) and time of peak filling rate (TPFR) were observed. Repeated measurement analysis of variance, independent-samples t test and Wilcoxon rank sum test were performed. Results In group A, the PER at 12 months after treatment ((3.11±0.48) end-di-astolic volume (EDV)/s) was lower than that before treatment ((3.60±0.62) EDV/s;F=3.447, t=0.60, P<0. 05), while there was no statistical difference between PER at 6 months after treatment ((3.34±0.57) EDV/s) and that before treatment (t=0.51, P>0. 05);the PFR at 6 months ((3.07±0.71) EDV/s) and 12 months after treatment ((2.84±0.54) EDV/s) declined significantly compared with that before treatment ((3. 57± 0. 81) EDV/s;F=5.345, t=0.82 and 0.75, both P<0. 05) . In group B, the PFR at 12 months after treat-ment ((2.86±0.55) EDV/s) declined significantly compared with that before treatment ((3.23±0. 87) EDV/s;F=3.214, t=0.84, P<0. 05) . The decrease of PFR at 6 months and 12 months after treatment in group A was greater than that in group B (-0.37(-0.78, 0. 15) vs -0.13(-0.44, 0.17) EDV/s; z=-1.569, P<0. 05) . Conclusions The gated equilibration ventriculography can effectively monitor the left ventricular function of breast cancer patients after targeted therapy. PER and PFR may be more sensitive than other pa-rameters to assess heart function changes. The lapatinib combined with taxeme-based chemotherapy can af-fect diastolic function more and earlier than lapatinib monotherapy.