多模態(tài)超聲在肝移植術(shù)后早期評估恢復情況中的應用價值
發(fā)布時間：2018-08-10 19:01
【摘要】：目的:自1963年首例人體肝移植手術(shù)開展以來,隨著肝移植手術(shù)技術(shù)日漸成熟、術(shù)后免疫抑制治療手段及監(jiān)測手段的日益完善,肝移植手術(shù)已經(jīng)成為治療各種終末期肝病的最佳手段。聲脈沖輻射力彈性成像(ARFI)與超聲造影(CEUS)均是目前超聲診斷技術(shù)的新熱點。前者可以通過定性、定量測量肝臟彈性硬度,評估肝纖維化、肝硬化情況,是了解肝臟物理硬度變化的很好的非侵入性臨床輔助診斷技術(shù)。后者通過外周靜脈注入微泡造影劑使體內(nèi)臟器微血管灌注顯影,從而直觀觀察病灶微循環(huán)情況,判斷病灶的性質(zhì)。這兩種技術(shù)均具有操作簡單、重復性好等優(yōu)點,具有較好的發(fā)展前景。我們利用這兩種技術(shù)評估肝移植手術(shù)患者一周內(nèi)的各項物理性質(zhì)改變,從而探討ARFI與CEUS在評估肝移植術(shù)后早期肝臟恢復情況中的臨床應用價值。方法:采用西門子ACUSON S2000彩色多普勒超聲診斷儀,配備ARFI彈性成像及CPS超聲造影成像模式。采用4C1凸陣探頭,頻率為4.5MHz,二維掃查機械指數(shù)為1.0-1.2,彈性成像模式下機械指數(shù)為1.7,超聲造影模式下機械指數(shù)為0.10-0.11。分別對ARFI組和CEUS組的術(shù)后一周內(nèi)患者及健康成年志愿者進行ARFI測量和CEUS檢查。比較患者一周內(nèi)超聲指標的動態(tài)改變,與同一天肝功能血生化指標(ALT、AST、ALP、γγ-GT、TBIL)進行相關(guān)性分析,并與健康人的超聲指標進行差異性分析。1.ARFI組:研究組為2015年9月至2016年11月在廣州軍區(qū)廣州總醫(yī)院進行肝移植手術(shù)并且術(shù)后一周內(nèi)恢復良好的19例患者;對照組為2015年9月至2016年11月期間肝炎、肝功能指標及肝臟彩超檢查結(jié)果均正常的15例健康成年人。2.CEUS組:研究組為2015年9月至2016年11月在廣州軍區(qū)廣州總醫(yī)院進行肝移植手術(shù),術(shù)后一周內(nèi)恢復良好并且無心臟病史、無造影劑過敏史、無心肺功能異常的14例患者;對照組為2015年9月至2016年11月期間肝炎、肝功能指標及肝臟彩超檢查結(jié)果均正常并且無造影劑過敏史的13例健康成年人。結(jié)果:聲脈沖輻射力彈性成像顯示:術(shù)后患者D1、D2、D3、D5、D7的肝臟彈性硬度以剪切波速度(SWV)表示,分別為(1.69±0.47)m/s、(1.56±0.37)m/s、(1.54±0.44)m/s、(1.47±0.30)m/s、(1.35±0.35)m/s,其趨勢表現(xiàn)為 D1 達到最高值,隨后一周內(nèi)逐步下降,至D7達一周最低值,D1與D7相比差異有統(tǒng)計學意義(P0.05)。健康人肝臟彈性硬度為(1.08±0.10)m/s,一周內(nèi)患者彈性硬度與健康人肝臟硬度相比,其硬度均高于健康肝臟,差異具有統(tǒng)計學意義(P0.05)。同時,D1、D2、D3、D5的SWV值與γ-GT相關(guān)性具有統(tǒng)計學意義(P0.05),與其他肝功能血生化指標相關(guān)性均無統(tǒng)計學意義,D7與所有肝功能血生化指標相關(guān)性均無統(tǒng)計學意義。超聲造影定量分析顯示了術(shù)后一周內(nèi)移植肝血流灌注特點:術(shù)后一周內(nèi)PI值緩慢上升,D3、D5之間上升幅度稍緩。TP曲線波動較明顯,D1為最低值,D3達到最高值后D5有所回落,D7小幅度上升。AUC從D1至D7平穩(wěn)上升,D7達到最高值。MTT曲線D1至D5呈上升趨勢,D7天有所回落。TIC參數(shù)反映了一周內(nèi)肝臟灌注的變化情況。術(shù)后一周內(nèi)移植肝與健康肝臟相比,D1、D3、D5、D7天的PI差異有統(tǒng)計學意義,D1天的AUC差異有統(tǒng)計學意義,均低于健康肝臟,余參數(shù)差異沒有統(tǒng)計學意義。同時一周內(nèi)的PI與血生化指標ALP、γ-GT相關(guān)性有統(tǒng)計學意義;MTT與TBIL相關(guān)性有統(tǒng)計學意義,余參數(shù)與血生化指標之間相關(guān)性無統(tǒng)計學意義。結(jié)論:ARFI技術(shù)能夠顯示移植肝術(shù)后早期肝臟硬度與健康人的區(qū)別,其一周內(nèi)SWV值波動曲線能夠反映早期肝臟硬度的變化,并與反映早期缺血再灌注損傷情況的肝功能血生化指標(γ-GT)具有較好相關(guān)性,能夠提示肝臟恢復情況的變化。ARFI在肝移植術(shù)后早期動態(tài)監(jiān)測評估方面具有良好的臨床應用價值。CEUS定量分析能夠顯示移植肝血流灌注特點,反映一周內(nèi)肝臟灌注的變化情況。同時,一周的PI、MTT與反映膽道受損情況的血生化指標ALP、γ-GT、TBIL具有相關(guān)性。CEUS在移植肝早期評估中具有一定應用價值,能夠評估移植肝一周內(nèi)微血管灌注的動態(tài)改變。
[Abstract]:OBJECTIVE: Since the first human liver transplantation was performed in 1963, with the maturation of liver transplantation techniques and the improvement of immunosuppressive therapy and monitoring methods, liver transplantation has become the best treatment for various end-stage liver diseases. Ultrasound is a new hotspot in diagnostic technology.The former can be used to measure the elastic hardness of liver qualitatively and quantitatively, evaluate the liver fibrosis and cirrhosis.It is a good non-invasive clinical auxiliary diagnostic technology to understand the changes of physical hardness of liver. These two techniques have the advantages of simple operation, good repeatability and good prospects for development. We used these two techniques to evaluate the changes of physical properties in a week after liver transplantation, and to explore the role of ARFI and CEUS in evaluating early liver recovery after liver transplantation. Methods: Siemens ACUSON S2000 color Doppler ultrasound diagnostic instrument was used, equipped with ARFI elastic imaging and CPS contrast-enhanced ultrasound imaging mode. 4C1 convex array probe was used, the frequency was 4.5 MHz, the mechanical index of two-dimensional scanning was 1.0-1.2, the mechanical index of elastic imaging mode was 1.7, and the mechanical index of contrast-enhanced ultrasound mode was 0.10-0. 11. ARFI and CEUS were measured in ARFI group and CEUS group within one week after operation, and CEUS was performed in healthy adult volunteers. Group A: The study group consisted of 19 patients who underwent liver transplantation in Guangzhou General Hospital of Guangzhou Military Region from September 2015 to November 2016 and recovered well within one week after operation; the control group consisted of 15 healthy adults with normal hepatitis, liver function and liver color Doppler ultrasound results from September 2015 to November 2016. Liver transplantation was performed in Guangzhou General Hospital of Guangzhou Military Region from January to November, 2016, and 14 patients recovered well within one week without any history of heart disease, contrast agent allergy and abnormal cardiopulmonary function. The control group had hepatitis from September, 2015 to November, 2016. The liver function indexes and liver color Doppler ultrasound examination results were normal and without contrast agent. Results: The elastic stiffness of D1, D2, D3, D5 and D7 was expressed as shear wave velocity (SWV), respectively (1.69.47) m/s, (1.56.37) m/s, (1.54.44) m/s, (1.47.30) m/s, (1.35.35) m/s, with a trend of D1 reaching the highest value within a week. The liver elastic hardness of healthy people was (1.08 There was no significant correlation between D7 and other liver function blood biochemical indexes (P 0.05). The quantitative analysis of contrast-enhanced ultrasound showed the characteristics of liver transplantation blood perfusion within one week after transplantation: PI value increased slowly within one week after transplantation, D3, D5 increased slightly. D1 was the lowest, D3 was the highest, D5 was the lowest, D7 was the lowest. AUC increased steadily from D1 to D7, D7 was the highest. MTT curves D1 to D5 showed an upward trend, D7 decreased. TIC parameters reflected the changes of liver perfusion in one week. Compared with healthy liver, D1, D3, D5, D7 days after transplantation. Meanwhile, the correlation between PI and serum biochemical indexes ALP and gamma-GT was statistically significant within one week; the correlation between MTT and TBIL was statistically significant; the correlation between remaining parameters and serum biochemical indexes was not statistically significant. CONCLUSION: ARFI can show the difference of liver stiffness between the early stage after liver transplantation and healthy people. The SWV fluctuation curve within one week can reflect the changes of liver stiffness in the early stage, and has a good correlation with the biochemical index of liver function (gamma-GT) reflecting the early stage of ischemia-reperfusion injury. CEUS quantitative analysis can show the characteristics of liver perfusion and reflect the changes of liver perfusion within one week. At the same time, one week PI and MTT are correlated with blood biochemical indexes ALP, gamma-GT and TBIL which reflect the damage of biliary tract. It can be used to evaluate the dynamic changes of microvascular perfusion within one week after liver transplantation.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R657.3
，
本文編號：2175910
[Abstract]:OBJECTIVE: Since the first human liver transplantation was performed in 1963, with the maturation of liver transplantation techniques and the improvement of immunosuppressive therapy and monitoring methods, liver transplantation has become the best treatment for various end-stage liver diseases. Ultrasound is a new hotspot in diagnostic technology.The former can be used to measure the elastic hardness of liver qualitatively and quantitatively, evaluate the liver fibrosis and cirrhosis.It is a good non-invasive clinical auxiliary diagnostic technology to understand the changes of physical hardness of liver. These two techniques have the advantages of simple operation, good repeatability and good prospects for development. We used these two techniques to evaluate the changes of physical properties in a week after liver transplantation, and to explore the role of ARFI and CEUS in evaluating early liver recovery after liver transplantation. Methods: Siemens ACUSON S2000 color Doppler ultrasound diagnostic instrument was used, equipped with ARFI elastic imaging and CPS contrast-enhanced ultrasound imaging mode. 4C1 convex array probe was used, the frequency was 4.5 MHz, the mechanical index of two-dimensional scanning was 1.0-1.2, the mechanical index of elastic imaging mode was 1.7, and the mechanical index of contrast-enhanced ultrasound mode was 0.10-0. 11. ARFI and CEUS were measured in ARFI group and CEUS group within one week after operation, and CEUS was performed in healthy adult volunteers. Group A: The study group consisted of 19 patients who underwent liver transplantation in Guangzhou General Hospital of Guangzhou Military Region from September 2015 to November 2016 and recovered well within one week after operation; the control group consisted of 15 healthy adults with normal hepatitis, liver function and liver color Doppler ultrasound results from September 2015 to November 2016. Liver transplantation was performed in Guangzhou General Hospital of Guangzhou Military Region from January to November, 2016, and 14 patients recovered well within one week without any history of heart disease, contrast agent allergy and abnormal cardiopulmonary function. The control group had hepatitis from September, 2015 to November, 2016. The liver function indexes and liver color Doppler ultrasound examination results were normal and without contrast agent. Results: The elastic stiffness of D1, D2, D3, D5 and D7 was expressed as shear wave velocity (SWV), respectively (1.69.47) m/s, (1.56.37) m/s, (1.54.44) m/s, (1.47.30) m/s, (1.35.35) m/s, with a trend of D1 reaching the highest value within a week. The liver elastic hardness of healthy people was (1.08 There was no significant correlation between D7 and other liver function blood biochemical indexes (P 0.05). The quantitative analysis of contrast-enhanced ultrasound showed the characteristics of liver transplantation blood perfusion within one week after transplantation: PI value increased slowly within one week after transplantation, D3, D5 increased slightly. D1 was the lowest, D3 was the highest, D5 was the lowest, D7 was the lowest. AUC increased steadily from D1 to D7, D7 was the highest. MTT curves D1 to D5 showed an upward trend, D7 decreased. TIC parameters reflected the changes of liver perfusion in one week. Compared with healthy liver, D1, D3, D5, D7 days after transplantation. Meanwhile, the correlation between PI and serum biochemical indexes ALP and gamma-GT was statistically significant within one week; the correlation between MTT and TBIL was statistically significant; the correlation between remaining parameters and serum biochemical indexes was not statistically significant. CONCLUSION: ARFI can show the difference of liver stiffness between the early stage after liver transplantation and healthy people. The SWV fluctuation curve within one week can reflect the changes of liver stiffness in the early stage, and has a good correlation with the biochemical index of liver function (gamma-GT) reflecting the early stage of ischemia-reperfusion injury. CEUS quantitative analysis can show the characteristics of liver perfusion and reflect the changes of liver perfusion within one week. At the same time, one week PI and MTT are correlated with blood biochemical indexes ALP, gamma-GT and TBIL which reflect the damage of biliary tract. It can be used to evaluate the dynamic changes of microvascular perfusion within one week after liver transplantation.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R657.3
，
本文編號：2175910
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