三维斑点追踪成像在不同年龄段乳腺癌化疗患者右心室亚临床收缩功能障碍评估中的应用研究-现代医学

三维斑点追踪成像在不同年龄段乳腺癌化疗患者右心室亚临床收缩功能障碍评估中的应用研究

单位：1. 新疆医科大学第四临床医学院, 新疆乌鲁木齐 830000;
2. 新疆医科大学第一附属医院超声科, 新疆乌鲁木齐 830000;
3. 新疆医科大学附属肿瘤医院超声科, 新疆乌鲁木齐 830000;
4. 新疆医科大学第三临床医学院, 新疆乌鲁木齐 830000;
5. 新疆医科大学第四

关键词：三维斑点追踪超声心动图乳腺癌化疗右心室功能

分类号：R737.9;R445.1;R541.7

出版年·卷·期（页码）：2026·54·第六期（888-894）

摘要：

目的：应用三维斑点追踪超声心动图(3D-STE)评估不同年龄段乳腺癌患者蒽环类化疗期间右心室收缩功能的动态演变特征。方法：选取2025年1月至2025年12月于新疆医科大学附属肿瘤医院经粗针穿刺活检确诊的50例乳腺癌患者为研究对象。按年龄分为≤45岁组(n=25)与＞45岁组(n=25)。于化疗前(T0)及第1、2、4周期化疗后(T1、T2、T4)行超声心动图检查，获取右心室整体纵向应变(3D-RVGLS)、右心室游离壁纵向应变(3D-RVFWLS)及常规参数并比较。分析心功能参数随化疗进程的纵向变化及年龄组别的影响，对每个心功能参数分别建立线性混合效应模型，评估时间主效应、组别主效应及时间×组别交互效应。此外，计算各参数在不同化疗阶段的变化量(ΔT0→T1、ΔT1→T2、ΔT2→T4)及全程总变化量(ΔT0→T4)，以明确不同年龄组右心室功能变化的差异。结果：线性混合效应模型显示，所有心功能参数均呈时间依赖性恶化(均P<0.001)。3D-RVGLS(F=7.95, P<0.001)、3D-RVFWLS(F=7.20, P<0.001)及右心室面积变化分数(RVFAC)(F=9.55, P<0.001)的时间×组别交互效应均有统计学意义。分阶段比较：T0→T1阶段，＞45岁组3D-RVFWLS下降幅度大于≤45岁组(t=-3.30，P=0.002)，且RVFAC下降幅度也大于≤45岁组(t=5.70，P<0.001)；T0→T4全程，＞45岁组3D-RVGLS与3D-RVFWLS的总下降幅度均大于≤45岁组(均P<0.001)，且RVFAC的总下降幅度也大于≤45岁组(t=2.445，P=0.019)。结论：3D-STE可早期识别蒽环类药物相关右心室亚临床收缩功能损伤。年龄与损伤进展密切相关，＞45岁患者呈现右心室功能衰退更早、更快的动态演变模式。

Objective: To evaluate the dynamic changes in right ventricular(RV) systolic function during anthracycline-based chemotherapy in breast cancer patients of different ages using 3D-STE. Methods: A total of 50 breast cancer patients confirmed by core needle biopsy at the Affiliated Cancer Hospital of Xinjiang Medical University from January 2025 to December 2025 were enrolled. Patients were divided into two groups according to age: ≤45 years group(n=25) and >45 years group(n=25). Echocardiographic examinations were performed before chemotherapy(T0) and after the 1st, 2nd, and 4th cycles(T1, T2, T4). Parameters including three-dimensional RV global longitudinal strain(3D-RVGLS), RV free wall longitudinal strain(3D-RVFWLS), and conventional echocardiographic indices were obtained and compared. Longitudinal changes in cardiac function parameters and the effect of age group were analyzed. A linear mixed-effects model was constructed for each cardiac function parameter to evaluate the main effect of time, main effect of group, and time×group interaction. In addition, changes at different chemotherapy stages(ΔT0→T1, ΔT1→T2, ΔT2→T4) and the total change over the entire course(ΔT0→T4) were calculated to compare RV function between the two age groups.Results:The linear mixed-effects model showed that all cardiac function parameters exhibited timedependent deterioration(all P<0.001). The time×group interaction effects were statistically significant for 3D-RVGLS(F=7.95,P<0.001), 3D-RVFWLS(F=7.20,P<0.001), and right ventricular fractional area change(RVFAC)(F=9.55,P<0.001). Stage-wise comparisons: during the T0→T1 period, the decrease in 3D-RVFWLS in the >45 years group was greater than that in the ≤45 years group(t=-3.30,P=0.002), and the decrease in RVFAC was also greater than that in the ≤45 years group(t=5.70,P<0.001). Over the entire T0→T4 course, the total decreases in both 3D-RVGLS and 3D-RVFWLS in the >45 years group were greater than those in the ≤45 years group(bothP<0.001), and the total decrease in RVFAC was also greater than that in the ≤45 years group(t=2.445,P=0.019). Conclusion: 3D-STE enables early detection of anthracycline-related subclinical right ventricular systolic dysfunction. Age is closely associated with injury progression, and patients aged >45 years exhibit a dynamic pattern of earlier and faster right ventricular functional decline.

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