本文選題：超聲檢查　切入點：聲輻射力脈沖成像　出處：《河北大學(xué)》2017年碩士論文

【摘要】：目的:探討應(yīng)用化療藥后藥物對兔肝造成的病理損害及其常規(guī)超聲表現(xiàn)和聲輻射力脈沖成像(ARFI)的測定值。方法:30只新西蘭白兔,均為雌性,體質(zhì)重2.5kg左右,隨機分為三組,每組10只。A組給予安慰劑+基礎(chǔ)飼料,B組給予化療藥+基礎(chǔ)飼料,C組給予化療藥+高脂飼料�；熕庍x用乳腺癌常用化療方案:環(huán)磷酰胺+表柔比星,用藥6個周期。用藥前每只兔耳緣靜脈抽血,作肝功、血脂檢查;作肝臟常規(guī)超聲檢查及ARFI檢查,測定剪切波速度,應(yīng)用化療藥6個周期后再行上述檢查。最后處死兔子,取出肝臟做病理切片觀察,所得結(jié)果與超聲結(jié)果進行對照。結(jié)果:A組用藥前后AST和ALT差異均無統(tǒng)計學(xué)意義(P0.05),B組和C組用藥后AST和ALT均較用藥前明顯升高(P0.05),用藥后B組和C組AST和ALT值均高于A組,C組又高于B組(P0.05)。A組用藥前后TC差異無統(tǒng)計學(xué)意義(P0.05),B組和C組用藥后TC均較用藥前明顯升高(P0.05),用藥后B組和C組TC值均高于A組,C組又高于B組(P0.05);A組和B組用藥后TG差異均無統(tǒng)計學(xué)意義(P0.05),C組用藥后TG較用藥前明顯升高(P0.05),且C組用藥后TG明顯高于A組和B組(P0.05);A組應(yīng)用安慰劑后超聲未見明顯異常;B、C組應(yīng)用化療藥后肝臟常規(guī)超聲顯示肝包膜增厚,體積輕度增大,外形飽滿,不同程度實質(zhì)回聲增強、不均勻,膽管壁及門脈回聲增強,肝內(nèi)外膽管及門脈未見擴張,C組更為明顯。A組用藥前后剪切波速度差異無統(tǒng)計學(xué)意義(P0.05),B組和C組用藥后剪切波速度均較用藥前增加(P0.05),用藥后B組和C組剪切波速度均高于A組(P0.05)。A組用藥后肝細胞病理結(jié)果未見明顯異常,B組用藥后有不同程度肝細胞水腫變性、點狀壞死、少許脂肪變性、匯管區(qū)血管擴張、淋巴細胞浸潤等,C組用藥后出現(xiàn)除B組所見的病理損害、較多的脂肪變性外,還可見肝細胞氣球樣變,肝細胞片狀壞死及局灶鈣化,局灶性纖維組織增生等。結(jié)論:(1)化療藥引起的兔肝細胞的腫脹、脂肪變性、匯管區(qū)炎癥反應(yīng)、小血管充血、局部纖維化及鈣化等病理改變是肝臟超聲圖像異常改變的基礎(chǔ)。(2)應(yīng)用中短期化療藥不能引起兔肝明顯的脂肪肝病理損害,ARFI可對化療藥物性肝損害進行定量評價。(3)化療期間高脂飲食可造成兔肝細胞明顯脂肪變性。
[Abstract]:Aim: to investigate the pathological damage of rabbit liver caused by chemotherapy and its routine ultrasonic findings and the value of ARFI in acoustic power pulse imaging (ARFI).Methods Thirty New Zealand white rabbits, all female, weighing about 2.5kg, were randomly divided into three groups: group A (n = 10) received placebo basic diet group B (n = 10) and group C (n = 10) were given chemotherapeutic high fat diet.Chemotherapy drugs commonly used in breast cancer: cyclophosphamide epirubicin, 6 cycles.Each rabbit was given liver function and blood lipids by the vein of auricular margin before medication, and the shear wave velocity was measured by routine ultrasound and ARFI examination of the liver, and the above examination was performed after 6 cycles of chemotherapeutic drugs.Finally, the rabbits were killed and the liver was taken out for pathological observation. The results were compared with those of ultrasound.Results there was no significant difference in AST and ALT between the two groups before and after treatment. The levels of AST and ALT in group B and C were significantly higher than those before administration. The AST and ALT values of group B and group C were higher than those of group A and group B respectively.TG in group C was significantly higher than that before treatment, and TG in group C was significantly higher than that in group A and group B after placebo.The volume was slightly enlarged, the shape was full, the echo of parenchyma was enhanced in different degree, and the echo of bile duct wall and portal vein was enhanced.There was no significant difference in shear wave velocity between group A and group A before and after treatment. The shear wave velocities of group B and group C were higher than those of group C before and after treatment, and the shear wave velocities of group B and group C were higher than those of group B and group C before and after treatment.The degree of hepatocyte edema in group A was higher than that in group A (P 0.05).In group C, such as punctate necrosis, a little fatty degeneration, vasodilation in the catchment area, lymphocyte infiltration, and so on, there were pathological lesions in group B and more adipose degeneration, but there were also balloon changes in hepatocytes.Hepatocyte flake necrosis and focal calcification, focal fibrous tissue proliferation and so on.Conclusion 1) the swelling, steatosis, inflammatory reaction in the catchment area and small vessel congestion caused by chemotherapeutic drugs in rabbit hepatocytes.Pathological changes such as Local Fibrosis and calcification are the basis of abnormal changes in liver Ultrasonography. 2) the use of medium and short term chemotherapeutic drugs can not cause obvious fatty liver pathological damage in rabbits. ARFI can quantitatively evaluate the hepatic damage induced by chemotherapeutic drugs.High fat diet during chemotherapy can cause significant fatty degeneration in rabbit hepatocytes.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R575

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