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目的探讨核素门控心肌灌注显像（GMPI）对乳腺癌化疗后并发心肌损害的早期诊断价值。方法选择2018年8月至2020年4月在我院接受化疗的乳腺癌180例患者，化疗方案均选择蒽环类药物（以注射用盐酸表柔比星为主），进行6个周期（每周期为21d）的治疗，在化疗前后对180例患者均行超声心动图及GMPI检测，并按照不同检测方式分为常规组（n=180）与研究组（n=180），常规组采用超声心动图进行检测，研究组采用GMPI进行检测。于化疗前（A1）、化疗第2周期末（A2）、化疗第4周期末（A3）、化疗第6周期末（A4）分别行超声心动图及GMPI检测，观察两种检查参数在不同时间点的变化情况；对比两种检测方式对心肌损害的检出率差异；绘制受试者工作特征（ROC）曲线评估两种检测方式对乳腺癌化疗患者发生心肌损害的早期诊断价值；再次绘制ROC曲线评估GMPI中具有显著变化的不同参数对化疗后发生心肌损害的临床诊断价值。结果超声心动图参数显示随着蒽环类药物剂量的增加，左心室射血分数（LVEF）呈显著下降趋势（P＜0.05），其他参数变化未见显著统计学差异（均P＞0.05）；GMPI参数显示随着蒽环类药物剂量的累积增加，LVEF呈显著下降趋势，相位标准差（SD）、相位直方图带宽（BW）、熵呈显著上升趋势（均P＜0.05），其他参数变化未见显著统计学差异（均P＞0.05）；GMPI对乳腺癌化疗后发生心肌损害的检出率显著高于超声心动图（P＜0.05）；ROC曲线显示，GMPI对乳腺癌术后化疗后产生心肌损害的曲线下面积显著高于超声心动图（P＜0.05）；另一ROC曲线结果显示，相比于GMPI单一参数检测，联合参数检测对诊断乳腺癌化疗后出现心肌损害的曲线下面积显著较高（P＜0.05）。结论相比于超声心动图，GMPI显像能更有效的在早期诊断出患者在化疗后是否发生心肌损害，且运用GMPI中的多参数联合检侧能进一步提高化疗后并发心肌损害的诊断率，可为乳腺癌化疗后心肌损害的早期诊断提供临床参考。

英文摘要:

Objective To investigate the value of radionuclide gated myocardial perfusion imaging (GMPI) in the early diagnosis of myocardial damage after chemotherapy in breast cancer. Methods 180 patients with breast cancer who received chemotherapy in our hospital from August 2018 to April 2020 were selected, anthracycline drugs (epirubicin hydrochloride for injection) were used in all chemotherapy regiments, 6 cycles (21 days per week) of treatment were performed, echocardiography and GMPI detection were performed on 180 patients before and after chemotherapy. According to different detection methods, they were divided into the conventional group (n=180) and the study group (n=180). The conventional group was detected by echocardiography, and the study group was detected by GMPI. Echocardiography and GMPI were performed before chemotherapy (A1), at the end of the second cycle of chemotherapy (A2), at the end of the fourth cycle of chemotherapy (A3) and at the end of the sixth cycle of chemotherapy (A4), respectively, the changes of the two examination parameters at different time points were observed. The detection rate of myocardial damage was compared between the two methods. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of the two detection methods in the early diagnosis of myocardial damage in patients with breast cancer chemotherapy. ROC curves were drawn again to evaluate the clinical diagnostic value of different parameters with significant changes in GMPI for myocardial damage after chemotherapy. Results Echocardiographic parameters showed that left ventricular ejection fraction (LVEF) decreased significantly with the increase of anthracycline dose (P＜0.05), and there was no significant difference in other parameters (all P>0.05). GMPI parameters showed that with the cumulative increase of anthracycline dose, LVEF showed a significant downward trend, phase standard deviation (SD), phase histogram bandwidth (BW) and entropy showed a significant upward trend (all P＜0.05), and there was no significant difference in other parameters (all P>0.05). The detection rate of myocardial damage in breast cancer after chemotherapy by GMPI was significantly higher than that by echocardiography (P＜0.05). ROC curve showed that the area under the curve of GMPI was significantly higher than that of echocardiography (P＜0.05). Another ROC curve showed that compared with GMPI single parameter detection, the area under the curve of combined parameter detection for the diagnosis of myocardial damage after chemotherapy in breast cancer was significantly higher (P<0.05). Conclusion Compared with echocardiography, GMPI imaging can be more effective in early diagnosis of myocardial damage in patients after chemotherapy, and the use of multiple parameters in GMPI can further improve the diagnosis rate of myocardial damage after chemotherapy, which can provide clinical reference for the early diagnosis of myocardial damage after chemotherapy in breast cancer.

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