中文摘要：

目的应用二维斑点追踪超声心动图（2DSTE）联合实时三维超声心动图（RT3DE）检测弥漫大B细胞淋巴瘤（DLBCL）患者蒽环类药物（ATC）化疗后左心室亚临床功能的变化。方法59例行ATC化疗的DLBCI。患者分别于化疗前、化疗2周期后（累积剂量100mg／m2）、4周期后（累积剂量20（）mg／m。）行2DSTE和RT3DE检查，脱机分析获得左心室整体长轴应变（GLS）、整体圆周应变（GCS）、左室心尖段旋转角度、心底段旋转角度。同时测量左心室舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）、射血分数（EF），并进行统计学分析。结果与化疗前比较，淋巴瘤患者左心室心尖段旋转角度、心底段旋转角度在化疗2周期后、4周期后均显著下降[心尖段旋转角度：（5．34±1．80）°对（3．80±1．45）°对（2．96±1．18）°；心底段旋转角度：（-3．32±1．14）。对（-2．65±1．12）°对（-2．56±1．19）。；P均〈0．01]；GLS、GCS在化疗4周期后显著降低[GLS：（-21．62±2．51）％对（-20．17±2．74）％；GCS：（-26．34±4．76）％对（-23．27±4．73）0o；P均〈0．01]。不同化疗时期EDV、ESV、SV、EF的变化差异均无统计学意义（P均〉0．（）5）。结论2DSTE能在早期检测出左心室亚临床功能的变化，左心室扭转参数较应变参数更敏感，显示低剂量ATC即对心肌造成的隐匿性损伤。

英文摘要：

Objective To evaluate the subclinical dysfunction of left ventricle （LV） induced by anthracycline （ATC） in patients with newly diagnosed diffuse large B-cell lymphoma （DLBCL） by two- dimensional speckle tracking echocardiography （ 2DSTE ） as well as real-time three-dimensional echocardiography （RT3DE）. Methods Traditional echocardiography images and RT3DE images were acquired from 59 patients with DLBCL before, after the completion of two cures（100 mg/m2 ） and four cures of the regimen（200 mg/m2）. LV global longitudinal strain （GLS）, global circumferential strain （GCS）, LV apical rotation and basal rotation, LV end-diastolic volume （EDV）, end-systolic volume （ESV）, stroke volume （SV） and ejection fraction （EF） were calculated simultaneously. Results Compared with baseline, LV apical rotation and basal rotation reduced significantly after two cures and four cures of therapy [LV apical rotation：（5.34 ± 1.80）° vs （3.80± 1.45）° vs （2.96± 1.18）°;LV basal rotation：（ -3.32± 1.14）° vs （- 2.65± 1.12）°vs （- 2.56± 1.19）°; both P〈0.01]. LV GLS and GCS decreased significantly till four cures of treatment compared with those at baseline [GLS ： （ - 21.62 ± 2.51 ） % vs （ - 20.17 ± 2.74） % ; GCS ： （ - 26.34 ± 4.76） ° vs （ - 23.27±4.73） 0/00 ; both P 〈0.01]. The alternation on EDV, ESV, SV and EFmanifested no visible degradation during the whole procedure （P 〈 0.05 for all）. Conclusions Cardiotoxicity during the early phase of anthracycline treatment can be detected via 2DSTE prior to the traditional echocardiographic expression of ventricular systolic function. The left ventrieular rotation index seems to be more sensitive than strain parameters for the estimation of early cardiac injury in patients with ATC chemotherapy. There is no safe dose for anthracycline in all patients with DLBCL treated with anthracycline even at lower doses.