目的：应用二维斑点追踪（2D-STI）分层应变技术评价乳腺癌患者使用蒽环类药物序贯曲妥珠单抗化疗后左室收缩功能的变化。方法：选取序贯应用蒽环类药物和曲妥珠单抗化疗的乳腺癌术后患者30例作为病例组（A组），另选取30例正常人作为对照组（B组）。A组患者分别于化疗前（T0期）、应用蒽环类药物化疗4周期后（T1期）及序贯应用曲妥珠单抗17周期后（T2期）采集图像并存储。测量各常规超声参数及心肌各层整体纵向应变（GLS），并比较是否存在差异。结果：①A组T0期与B组常规超声参数及心肌各层GLS比较差异无统计学意义（P均＞0.05）；②A组T1期、T2期与T0期分别比较LVEF无统计学意义（P＞0.05），而T1期心内膜下心肌GLS较T0期明显减低，T2期心内膜下心肌与心肌中层GLS均较T0期明显减低，差异有统计学意义（P均＜0.01）；③A组T2期与T1期比较LVEF差异无统计学意义，T2期心内膜下心肌与心肌中层GLS较T1期明显减低，差异有统计学意义（P＜0.05）。结论：2D-STI分层应变技术通过分析心肌各层整体纵向应变能够较为准确评价左室收缩功能，进而早期发现乳腺癌患者蒽环类药物与曲妥珠单抗序贯化疗后出现的亚临床心脏毒性损伤。

Objective: To evaluate the changes of left ventricular systolic function in breast cancer patients after sequential application of anthracyclines and trastuzumab chemotherapy by two-dimensional speckle tracking imaging(2D-STI) layer-specific strain analysis. Methods: Thirty patients diagnosed with breast cancer and sequential application of chemotherapy and anthracycline-trastuzumab were selected as the case group(group A), and 27 normal subjects were selected as the control group(group B). The 2D images of patients in group A were collected and stored before chemotherapy(T0 phase), after 4 cycles of anthracycline(T1 phase) and after sequential 17 cycles of trastuzumab(T2 phase). The conventional echocardiographic parameters and the global longitudinal strain(GLS) in each myocardial layer were measured and compared. Results: ①There were no significant differences in the conventional echocardiographic parameters and GLS between the group A in the T0 phase and group B(P>0.05). ②There was no significant difference in the LVEF between T1, T2 and T0 phases in the group A(P>0.05). In the T1 phase, the endocardial GLS was significantly lower than that in the T0 phase. The endocardial and mid-myocardial GLS in the T2 phase were significantly lower than those in the T0 phase, and the differences were statistically significant(P<0.01). ③There was no significant difference in LVEF between the T2 and T1 phases in group A. The endocardial and midmyocardial GLS in the T2 phase were significantly lower than those in the T1 phase. The difference was statistically significant(P<0.05). Conclusion: The 2D-STI layer-specific strain analysis could accurately evaluate the left ventricular systolic function by analyzing the GLS in each myocardial layer, so it might be used to reflect the subclinical cardiotoxicity of patients after sequential application of anthracyclines and trastuzumab.