【摘要】：目的： 探討超聲造影（CEUS）定量分析在結(jié)直腸癌肝轉(zhuǎn)移化療和靶向治療（貝伐單抗聯(lián)合化療）療效早期預(yù)測和評估中的應(yīng)用價值，為臨床早期判斷療效和預(yù)后或制定治療方案提供依據(jù)。 方法： （1）設(shè)定入組標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)，選取年齡18-75歲之間經(jīng)病理學(xué)和/或細(xì)胞學(xué)證實的預(yù)進(jìn)行化療和貝伐單抗聯(lián)合化療的結(jié)直腸癌肝轉(zhuǎn)移患者，有超聲影像和CT影像可測量的病灶；無重要器官的功能障礙，，血常規(guī)、肝、腎功能及心臟功能基本正常，預(yù)計生存期3個月以上，能理解本研究的并簽署知情同意書者。 （2）對符合標(biāo)準(zhǔn)的61例結(jié)直腸癌肝轉(zhuǎn)移患者隨機(jī)行化療和貝伐單抗聯(lián)合化療（化療組為26例，貝伐單抗聯(lián)合化療組為35例），在治療前及給藥后第3、7、14、42、60天分別行常規(guī)超聲及CEUS檢查，并于治療后第一個月末和第二個月末行增強(qiáng)CT檢查。且依據(jù)治療后增強(qiáng)CT檢查的兩個月評判結(jié)果，將61例結(jié)直腸癌肝轉(zhuǎn)移患者分為治療有效組和治療無效組。 （3）使用SonoTumor定量分析軟件對時間強(qiáng)度曲線的六個功能參數(shù)進(jìn)行計算。選取的時間強(qiáng)度曲線的六個功能參數(shù)，分別為上升時間（RT）、平均渡越時間（mTT）、峰值強(qiáng)度（PE）、流入相曲線下面積（WiAUC）、流入相斜率（WiR）、流入相灌注指數(shù)（WiPI）。其中，上升時間（RT）為峰值強(qiáng)度從10%上升到90%的所需時間。平均渡越時間（mTT）為從強(qiáng)度開始上升到峰值強(qiáng)度下降一半所需時間。峰值強(qiáng)度（PE）為達(dá)到峰值時的信號強(qiáng)度，與血流最大流量相關(guān)。流入相曲線下面積（WiAUC）為曲線上升支下的面積，與流入相的血流灌注量相關(guān)。流入相斜率（WiR）與血流最大流量及灌注時間相關(guān)。流入指數(shù)（WIPI）為流入相曲線下面積除以流入時間。 （4）采用改良實體瘤療效評價標(biāo)準(zhǔn)（mRECIST標(biāo)準(zhǔn)），分別針對治療有效組和治療無效組進(jìn)行結(jié)直腸癌肝轉(zhuǎn)移化療和靶向治療療效評估，分析時間強(qiáng)度曲線六個定量參數(shù)與mRECIST標(biāo)準(zhǔn)的相關(guān)性。 結(jié)果： （1）化療治療有效組和治療無效組，治療前CEUS定量分析的上升時間(RT)、平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(wiR)和流入相灌注指數(shù)(WiPI)差異無統(tǒng)計學(xué)意義(P0.05)。 （2）貝伐單抗聯(lián)合化療治療有效組治療前CEUS定量分析的上升時間(RT)差異有統(tǒng)計學(xué)意義(P0.05)，而平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(wiR)和流入相灌注指數(shù)(WiPI)差異無統(tǒng)計學(xué)意義(P0.05)。貝伐單抗聯(lián)合化療治療無效組治療前CEUS定量分析的上升時間(RT)、平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(wiR)和流入相灌注指數(shù)(WiPI)差異無統(tǒng)計學(xué)意義(P0.05)。 （3）化療有效組與無效組相比較，CEUS定量分析參數(shù)中的上升時間(RT)在治療后第3天較治療前延長(P0.05)，而平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(WiR)和流入相灌注指數(shù)(WiPI)在治療后第3天差異無統(tǒng)計學(xué)意義(P0.05)。且CEUS定量分析各功能參數(shù)上升時間(RT)、平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(wiR)和流入相灌注指數(shù)(WiPI)在治療后第7、14、42、60天差異無統(tǒng)計學(xué)意義(P0.05)。 （4）貝伐單抗聯(lián)合化療有效組與無效組相比較，CEUS定量分析參數(shù)中的上升時間(RT)、平均渡越時間(mTT)在治療后第3天較治療前延長(P0.05)，而流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(WiR)和流入相灌注指數(shù)(WiPI)在治療后第3天差異無統(tǒng)計學(xué)意義(P0.05)。且CEUS定量分析各功能參數(shù)上升時間(RT)、平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(wiR)和流入相灌注指數(shù)(WiPI)在治療后第7、14、42、60天差異無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論： （1）超聲造影定量分析時間強(qiáng)度曲線的六個功能參數(shù)（上升時間(RT)、平均渡越時間(mTT)、流入相曲線下面積(WiAUC)、峰值強(qiáng)度(PE)、流入相比率(wiR)和流入相灌注指數(shù)(WiPI)）是早期預(yù)測和評估結(jié)腸癌肝轉(zhuǎn)移化療和靶向治療療效的指標(biāo)。其中，上升時間(RT)是早期預(yù)測和評估結(jié)腸癌肝轉(zhuǎn)移化療療效的有效指標(biāo)，上升時間(RT)、平均渡越時間(mTT)是早期預(yù)測和評估結(jié)腸癌肝轉(zhuǎn)移靶向治療療效的有效指標(biāo)。 （2）超聲造影定量分析有望成為早期預(yù)測和評估結(jié)直腸癌肝轉(zhuǎn)移化療和靶向治療療效的影像學(xué)方法。
[Abstract]:Purpose: To evaluate the value of the quantitative analysis of CEUS in the early prediction and evaluation of the curative effect of liver transfer chemotherapy and targeted therapy (bevacizumab in combination with chemotherapy) in colorectal cancer, and to provide the basis for the early judgment of the curative effect and the prognosis or the formulation of the treatment plan. It was reported. Methods: (1) To set the criteria for inclusion and exclusion, and to select the patients with colorectal cancer who were pre-treated by pathology and/ or cytological confirmation between 18 and 75 years of age, with the combination of chemotherapy and bevacizumab, and the ultrasound and CT images may The measured lesions; the function of non-vital organs, blood routine, liver, kidney function and heart function are basically normal, the survival time is more than 3 months, and the study is understood and signed (2) The combination of chemotherapy and bevacizumab in 61 patients with colorectal cancer (26 patients in the chemotherapy group and 35 in the combination of the bevacizumab and the chemotherapy group) was performed in 61 patients with colorectal cancer according to the standard. Routine ultrasound was performed at the 3rd, 7th, 14th, 42nd and 60th day before and after treatment. and CEUS, and at the end of the first month and the end of the second month after the treatment In line-enhanced CT,61 patients with colorectal cancer were divided into treatment effective according to the two-month evaluation of the post-treatment enhanced CT. And treatment of the invalid group. (3)6.6.6.6.6.6.6.6.6.6.3)6.6.6.6.6.6.6. The function parameters are calculated. The six functional parameters of the selected time intensity curve are rise time (RT), mean transit time (mTT), peak intensity (PE), area under the inflow phase curve (WiAUC), inflow phase slope (WiR), inflow phase irrigation, Note Index (WPI), where the rise time (RT) is the peak intensity rising from 10% The required time to 90%. The average transit time (mTT) is rising from the strength to the peak the peak intensity (pe) is the signal strength when the peak is reached, The area under the inflow phase curve (WiAUC) is the area under the rising branch of the curve and is related to the inflow Related to the amount of blood flow in the phase. The inflow phase slope (WiR) and the blood flow are the largest Flow and irrigation time-related. The inflow index (WIPI) is the inflow phase curve The lower area divided by the inflow time; (4) the modified solid tumor effect evaluation standard (mRECIST standard) was adopted to evaluate the effect of the treatment of the liver metastasis and the targeted treatment of the colorectal cancer in the treatment effective group and the treatment ineffective group, and the six quantitative parameters of the time intensity curve and the mR were analyzed. ECI Results: (1) The effective and ineffective treatment group, the rise time (RT), mean transit time (mTT) of the pre-treatment CEUS quantitative analysis, the area under the inflow phase curve (mTT). WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiPI) There was no significant difference (P0.05). (2) The rise time (RT) of CEUS quantitative analysis before and after treatment with bevacizumab in combination with chemotherapy was of statistical significance (P0.05), while the mean transit time (mTT) was below the phase curve. product (WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiP I) The difference was not significant (P0.05). The rise time (RT), mean transit time (mTT) of the pre-treatment CEUS quantitative analysis with bevacizumab in combination with chemotherapy and the inflow phase curve product (WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiP (3) The rise time (RT) in the quantitative analysis of CEUS was prolonged before the treatment (P0.05), while the mean transit time (mTT) and the inflow phase curve were not statistically significant (P0.05). The lower area (WiAUC), peak intensity (PE), inflow rate (WiR), and inflow phase perfusion index (WiPI) were treated The 3-day difference was not statistically significant (P0.05). The CEUS quantitative analysis of the function parameter rise time (RT), the mean transit time (mTT), the area under the inflow phase (WiAUC), the peak intensity (PE), the inflow rate (wiR), and the inflow phase perfusion index (WiPI) were the 7th, 14th, and 42 after treatment. (4) The rise time (RT) and mean transit time (mTT) in the CEUS quantitative parameters were prolonged before the treatment (P0.05). Area under the curve (WiAUC), peak intensity (PE), inflow rate (WiR), and inflow phase perfusion index (WiPI) were There was no significant difference in the 3-day difference after treatment (P0.05), and the CEUS quantitative analysis of the function parameter rise time (RT), mean transit time (mTT), the area under the inflow phase curve (WiAUC), the peak intensity (PE), the inflow rate (wiR) and the inflow-phase perfusion index (WiPI) were the 7th and 14th after treatment. 42, Conclusion: (1) The six functional parameters (rise time (RT) and mean transit time (mTT) of the time intensity curve for the quantitative analysis of the ultrasonic contrast. , the area under the inflow phase (WiAUC), the peak intensity (PE), the inflow rate (wiR), and the inflow phase perfusion index (WiPI)) are Early prediction and evaluation of the index of the efficacy of colon cancer liver metastasis chemotherapy and targeted therapy, in which the rise time (RT) is an effective index, rise time (RT), mean transit time (mTT) for early prediction and evaluation of the efficacy of colon cancer liver metastasis chemotherapy. It is an effective index for early prediction and evaluation of the efficacy of targeted therapy for colon cancer liver metastasis. (2) The quantitative analysis of ultrasound is expected to be an early stage.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R735.34;R445.1

【參考文獻(xiàn)】

相關(guān)博士學(xué)位論文 前1條

1 曹小麗;超聲造影在乳腺癌診斷及療效評估中的應(yīng)用研究[D];山東大學(xué);2012年

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