目的 探讨超声心动图在评估白血病患儿蒽环类药物化疗后心肌损伤的临床价值。 方法 选取2020年6月—2025年5月苏州市吴江区儿童医院267例行蒽环类药物化疗的白血病患儿。根据肌钙蛋白Ⅰ水平分为心肌损伤组（n=81）和无心肌损伤组（n=186）。比较两组患儿临床、心肌损伤及超声心动图指标；采用随机森林算法筛选影响因素，多因素logistic回归分析独立影响因素；采用受试者工作特征曲线评估各影响因素单独及联合检测的预测效能，并采用DeLong检验比较联合检测效能在不同性别、年龄亚组中的差异。 结果 随机森林分析显示，变量数为左室射血分数（left ventricular ejection fraction, LVEF）、蒽环类药物累积剂量、左室舒张末期容积指数、左室收缩末期容积指数、E峰速度（E）、A峰速度（A）、E/A比值时，袋外数据误差率最低。多因素logistic回归分析显示，蒽环类药物累积剂量（OR=8.998，95%CI：4.759~15.013）及化疗前LVEF（OR=7.714，95%CI：3.985~14.932）、E/A比值（OR=12.207，95%CI：6.269~23.769）、E（OR=5.842，95%CI：2.959~11.532）、A（OR=7.114，95%CI：3.913~12.933）均是化疗后心肌损伤的独立影响因素（P<0.05）。受试者工作特征曲线分析显示，联合检测的预测效能（曲线下面积为0.936）优于单一指标，灵敏度为0.820，特异度为0.917；同时在性别及年龄分层下均有较好的预测效能。 结论 超声心动图参数LVEF、E、A、E/A比值联合蒽环类药物累积剂量对白血病患儿化疗后心肌损伤具有较高的预测效能，适用于不同性别、年龄的患儿。

Objective To evaluate the clinical value of echocardiography in assessing myocardial injury following anthracycline chemotherapy in children with leukemia. Methods A total of 267 children with leukemia who received anthracycline-based chemotherapy at Suzhou Wujiang District Children's Hospital from June 2020 to May 2025 were enrolled. Based on cardiac troponin I levels, the children were divided into a myocardial injury group (n=81) and a non-myocardial injury group (n=186). Clinical data, myocardial injury markers, and echocardiographic parameters were compared between groups. A random forest algorithm was used to screen for influencing factors, and multivariable logistic regression was employed to identify independent predictors. Receiver operating characteristic curve analysis was used to evaluate the predictive performance of individual and combined factors, and the DeLong test was employed to compare combined diagnostic performance across sex- and age-stratified subgroups. Results Random forest analysis indicated the lowest out-of-bag error rate when the model included left ventricular ejection fraction (LVEF), cumulative anthracycline dose, left ventricular end-diastolic volume index, left ventricular end-systolic volume index, E-wave velocity, A-wave velocity, and E-wave velocity/A-wave velocity (E/A) ratio. Multivariable logistic regression showed that cumulative anthracycline dose (OR=8.998, 95%CI: 4.759-15.013), and pre-chemotherapy LVEF (OR=7.714, 95%CI: 3.985-14.932), E/A ratio (OR=12.207, 95%CI: 6.269-23.769), E-wave velocity (OR=5.842, 95%CI: 2.959-11.532), and A-wave velocity (OR=7.114, 95%CI: 3.913-12.933) were independent predictors of myocardial injury following chemotherapy (P<0.05). Receiver operating characteristic curve analysis showed that the combined diagnostic model achieved superior predictive performance compared with any single indicator, with an area under the curve of 0.936, sensitivity of 0.820, and specificity of 0.917; predictive efficacy was maintained in both sex- and age-stratified subgroups. Conclusions A combined model integrating echocardiographic parameters (LVEF, E-wave velocity, A-wave velocity, and E/A ratio) with cumulative anthracycline dose demonstrates high predictive efficacy for post-chemotherapy myocardial injury in children with leukemia and is applicable across sexes and age groups.