多模态超声在肝移植术后早期评估恢复情况中的应用价值
发布时间：2018-08-10 19:01
【摘要】：目的:自1963年首例人体肝移植手术开展以来,随着肝移植手术技术日渐成熟、术后免疫抑制治疗手段及监测手段的日益完善,肝移植手术已经成为治疗各种终末期肝病的最佳手段。声脉冲辐射力弹性成像(ARFI)与超声造影(CEUS)均是目前超声诊断技术的新热点。前者可以通过定性、定量测量肝脏弹性硬度,评估肝纤维化、肝硬化情况,是了解肝脏物理硬度变化的很好的非侵入性临床辅助诊断技术。后者通过外周静脉注入微泡造影剂使体内脏器微血管灌注显影,从而直观观察病灶微循环情况,判断病灶的性质。这两种技术均具有操作简单、重复性好等优点,具有较好的发展前景。我们利用这两种技术评估肝移植手术患者一周内的各项物理性质改变,从而探讨ARFI与CEUS在评估肝移植术后早期肝脏恢复情况中的临床应用价值。方法:采用西门子ACUSON S2000彩色多普勒超声诊断仪,配备ARFI弹性成像及CPS超声造影成像模式。采用4C1凸阵探头,频率为4.5MHz,二维扫查机械指数为1.0-1.2,弹性成像模式下机械指数为1.7,超声造影模式下机械指数为0.10-0.11。分别对ARFI组和CEUS组的术后一周内患者及健康成年志愿者进行ARFI测量和CEUS检查。比较患者一周内超声指标的动态改变,与同一天肝功能血生化指标(ALT、AST、ALP、γγ-GT、TBIL)进行相关性分析,并与健康人的超声指标进行差异性分析。1.ARFI组:研究组为2015年9月至2016年11月在广州军区广州总医院进行肝移植手术并且术后一周内恢复良好的19例患者;对照组为2015年9月至2016年11月期间肝炎、肝功能指标及肝脏彩超检查结果均正常的15例健康成年人。2.CEUS组:研究组为2015年9月至2016年11月在广州军区广州总医院进行肝移植手术,术后一周内恢复良好并且无心脏病史、无造影剂过敏史、无心肺功能异常的14例患者;对照组为2015年9月至2016年11月期间肝炎、肝功能指标及肝脏彩超检查结果均正常并且无造影剂过敏史的13例健康成年人。结果:声脉冲辐射力弹性成像显示:术后患者D1、D2、D3、D5、D7的肝脏弹性硬度以剪切波速度(SWV)表示,分别为(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,其趋势表现为 D1 达到最高值,随后一周内逐步下降,至D7达一周最低值,D1与D7相比差异有统计学意义(P0.05)。健康人肝脏弹性硬度为(1.08±0.10)m/s,一周内患者弹性硬度与健康人肝脏硬度相比,其硬度均高于健康肝脏,差异具有统计学意义(P0.05)。同时,D1、D2、D3、D5的SWV值与γ-GT相关性具有统计学意义(P0.05),与其他肝功能血生化指标相关性均无统计学意义,D7与所有肝功能血生化指标相关性均无统计学意义。超声造影定量分析显示了术后一周内移植肝血流灌注特点:术后一周内PI值缓慢上升,D3、D5之间上升幅度稍缓。TP曲线波动较明显,D1为最低值,D3达到最高值后D5有所回落,D7小幅度上升。AUC从D1至D7平稳上升,D7达到最高值。MTT曲线D1至D5呈上升趋势,D7天有所回落。TIC参数反映了一周内肝脏灌注的变化情况。术后一周内移植肝与健康肝脏相比,D1、D3、D5、D7天的PI差异有统计学意义,D1天的AUC差异有统计学意义,均低于健康肝脏,余参数差异没有统计学意义。同时一周内的PI与血生化指标ALP、γ-GT相关性有统计学意义;MTT与TBIL相关性有统计学意义,余参数与血生化指标之间相关性无统计学意义。结论:ARFI技术能够显示移植肝术后早期肝脏硬度与健康人的区别,其一周内SWV值波动曲线能够反映早期肝脏硬度的变化,并与反映早期缺血再灌注损伤情况的肝功能血生化指标(γ-GT)具有较好相关性,能够提示肝脏恢复情况的变化。ARFI在肝移植术后早期动态监测评估方面具有良好的临床应用价值。CEUS定量分析能够显示移植肝血流灌注特点,反映一周内肝脏灌注的变化情况。同时,一周的PI、MTT与反映胆道受损情况的血生化指标ALP、γ-GT、TBIL具有相关性。CEUS在移植肝早期评估中具有一定应用价值,能够评估移植肝一周内微血管灌注的动态改变。
[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.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R657.3
，
本文编号：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.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R657.3
，
本文编号：2175910
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