中文摘要：

目的蒽环类药物（ATC）对左右心功能均有损伤。本研究旨在应用超声心动图综合评价淋巴瘤患者经ATC化疗后右心系统亚临床功能的改变。方法74例采用ATC治疗的淋巴瘤患者分别于化疗前及化疗2、4、6周期后行常规经胸二维超声心动图检查，获得右心房（RA）及右心室（RV）舒张末面积（EDA）、收缩末面积（ESA）和RV舒张末容积（EDV）、收缩末容积（ESV）及RV射血分数（EF）；应用组织多普勒显像（TDI）获得三尖瓣环收缩期峰值速度和舒张早、晚期峰值速度；应用二维斑点追踪显像（2DSTE）技术分析右心室游离壁收缩期峰值应变及峰值应变率。结果与化疗前相比，淋巴瘤患者化疗2、4周期后所有参数变化差异均无统计学意义（P〉0．05）。化疗6周期后，应用TDI及2DSTE所得的各项参数变化差异仍均无统计学意义（P〉0．05）；而RAEDA（（6．6±1．9）cm2 VS（7．7m2．4）cm2）、RAESA（（8．8±2．5）cm2vs（10．8±2．8）cm2）、RVEDA（（14．1±3．4）cm2vs（16．2±3．7）cm2）、RVESA（（7．9±1．9）cm2vs（9．0±2．2）cm：）在化疗6周期后显著增大，其差异均有统计学意义（F=4．574，P=0．004；F=7．515，P=0．000；F=4．955，P=0．002；F=4．228，P=0．006）；与此同时，RVEDV（（29．8±10．5）ml vs（37．0±12．7）ml）、RVESV（（12．7±4．4）ml vs（15．0±5．2）ml）明显增大，RVEF（（59．4±5．8）％vs（56．4±5．8）％）显著下降，但仍维持在正常范围内，其差异均有统计学意义（F=5．168，P=0．002；F=2．829，P=0．039；F=3．961，P=0．009）。化疗期间左心室射血分数（LVEF）变化差异无统计学意义（P〉0．05）。结论超声心动图可用于早期无创评估ATC所致右心系统亚临床功能损害。ATC致右心系统损伤首先表现为形态学改变；此外，RVEF有望成为评估ATC所致右心功能损伤的有价值指标。

英文摘要：

Objective Both right and left ventricular function should be taken into account in the assessment of anthraeycline （ATC）-induced eardiotoxieity. The aim of this study was to assess the subclinical dysfunction of fight cardiac system in patients with newly diagnosed lymphoma who received ATC treatment by echoeardiography. Methods A total of 74 patients with lymphoma who received ATC treatment were enrolled. Each patient underwent transthoracic eehocardiographic examination before chemotherapy as well as after two, four and six cycles of ATC remedy. Right atrial （RA） and right ventrieular （RV） end-diastolic area （EDA） and end-systolic area （ESA） were calculated. RV end-diastolic volume （EDV） and end-systolic volume （ESV）, as well as RV ejection fraction （EF） were measured simultaneously. Tissue Doppler imaging （TDI） measurements of systolic and early or late diastolic myocardial velocities of RV free wall at tricuspid annuals were also analyzed. Two-dimensional speckle tracking echocardiography （2DSTE） was conducted to evaluate RV free wall strain along with strain rate. Results None of the echocardiographic parameters showed significant alteration after two and four cycles of chemotherapy compared with those at baseline （P〉0.05）. At the end of the therapy （i.e. after six cycles of ATC treatment）, there wasstill no statistical difference on TDI data as well as 2DSTE measurements （P〉0.05）. An unexpected finding was that the RAEDA（（6.6±1.9） cm2 vs （7.7±2.4） cm2） and RAESA （（8.8±2.5） cm2 vs （10.8±2.8） cm2） revealed obvious dilatation after six cures of the regimen compared with those at baseline （P〈0.01）. Similar morphologic characteristics displayed on the RVEDA （（14.1±3.4） cm2 vs （16.2±3.7） cm2） and RVESA （（7.9±1.9） cm2 vs （9.0±2.2） cm2） （P〈0.01） simultaneously. Furthermore, RVEDV （（29.8±10.5） ml vs （37.0±12.7） ml） and RVESV （（12.7±4.4） ml vs （15.0±5.2） ml）, as well