生长分化因子-15 和组织多普勒成像在检测儿童癌症幸存者无症状蒽环类抗生素心肌病中的应用。

Growth-differentiation factor-15 and tissue doppler ımaging in detection of asymptomatic anthracycline cardiomyopathy in childhood cancer survivors.

机构信息

Selcuk University Medical Faculty, Department of Pediatric Cardiology, Konya, Turkey.

出版信息

Clin Biochem. 2013 Sep;46(13-14):1239-43. doi: 10.1016/j.clinbiochem.2013.06.029. Epub 2013 Jul 11.

DOI:10.1016/j.clinbiochem.2013.06.029

PMID:23850849

Abstract

OBJECTIVES

Anthracyclines have led to an increased risk of cardiac morbidity and mortality. Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Tissue Doppler imaging (TDI) also has potential as a clinically useful technique for the assessment of myocardial function. Biochemical markers may be used to detect cardiac damage growth-differentiation factor-15 (GDF-15) and are emerging as a biomarker of cardiac dysfunction. The aim of this study is to assess the value of the plasma levels of GDF-15 and TDI in detecting late myocardial dysfunction in childhood cancer survivors (CCS) who were treated with anthracyclines.

DESIGN AND METHODS

Thirty-eight CCS who had completed chemotherapy treatment with anthracyclines were included in this study. Control group consisted of 32 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. However, GDF-15 and cardiac troponin-I (cTnI) were measured.

RESULTS

Although, systolic function of the left ventricular was similar in all groups, there were significant differences between parameters of diastolic function of the heart. The mitral valve E wave, E/A ratio, left ventricular E'm wave, and E'm/A'm ratio were different in the patients than in the controls (p = 0.049, p = 0.037, p < 0.0001, p = 0.001, respectively). The tricuspid valve E/A ratio, right ventricular E't wave, and E't/A't ratio in the patients were also different from those of the controls (p = 0.031, p < 0.0001, p < 0.0001, respectively). Mean plasma GDF-15 was significantly higher in patients than healthy controls (p = 0.027). There were no significant differences in cTnI between both groups.

CONCLUSIONS

Growth-differentiation factor-15 level may be used as a biomarker of anthracycline-induced cardiovascular disease severity in the CCS.

摘要

目的

蒽环类药物会增加心脏发病率和死亡率。癌症幸存者的迟发性心脏并发症可能源于亚临床心肌损伤。组织多普勒成像（TDI）也可能成为评估心肌功能的临床有用技术。生化标志物可用于检测心肌损伤，生长分化因子 15（GDF-15）是一种新兴的心脏功能障碍生物标志物。本研究旨在评估蒽环类药物治疗后发生心脏肿瘤的儿童幸存者（CCS）中 GDF-15 血浆水平和 TDI 检测晚期心肌功能障碍的价值。

设计与方法

本研究纳入了 38 名接受蒽环类药物化疗的 CCS。对照组由 32 名年龄和性别匹配的健康志愿者组成。所有儿童均接受详细的超声心动图检查，包括 M 型、脉冲多普勒和组织多普勒成像。然而，GDF-15 和心脏肌钙蛋白 I（cTnI）也进行了测量。

结果

尽管左心室收缩功能在所有组中相似，但心脏舒张功能参数存在显著差异。患者组的二尖瓣 E 波、E/A 比值、左心室 E'm 波和 E'm/A'm 比值与对照组不同（p=0.049，p=0.037，p<0.0001，p=0.001）。患者组的三尖瓣 E/A 比值、右心室 E't 波和 E't/A't 比值也与对照组不同（p=0.031，p<0.0001，p<0.0001）。患者组的平均 GDF-15 血浆水平明显高于健康对照组（p=0.027）。两组间 cTnI 无显著差异。