常规超声及声辐射力脉冲成像检测化疗药物肝损害的实验研究

发布时间：2018-03-30 12:55

本文选题：超声检查　切入点：声辐射力脉冲成像　出处：《河北大学》2017年硕士论文

【摘要】：目的:探讨应用化疗药后药物对兔肝造成的病理损害及其常规超声表现和声辐射力脉冲成像(ARFI)的测定值。方法:30只新西兰白兔,均为雌性,体质重2.5kg左右,随机分为三组,每组10只。A组给予安慰剂+基础饲料,B组给予化疗药+基础饲料,C组给予化疗药+高脂饲料。化疗药选用乳腺癌常用化疗方案:环磷酰胺+表柔比星,用药6个周期。用药前每只兔耳缘静脉抽血,作肝功、血脂检查;作肝脏常规超声检查及ARFI检查,测定剪切波速度,应用化疗药6个周期后再行上述检查。最后处死兔子,取出肝脏做病理切片观察,所得结果与超声结果进行对照。结果:A组用药前后AST和ALT差异均无统计学意义(P0.05),B组和C组用药后AST和ALT均较用药前明显升高(P0.05),用药后B组和C组AST和ALT值均高于A组,C组又高于B组(P0.05)。A组用药前后TC差异无统计学意义(P0.05),B组和C组用药后TC均较用药前明显升高(P0.05),用药后B组和C组TC值均高于A组,C组又高于B组(P0.05);A组和B组用药后TG差异均无统计学意义(P0.05),C组用药后TG较用药前明显升高(P0.05),且C组用药后TG明显高于A组和B组(P0.05);A组应用安慰剂后超声未见明显异常;B、C组应用化疗药后肝脏常规超声显示肝包膜增厚,体积轻度增大,外形饱满,不同程度实质回声增强、不均匀,胆管壁及门脉回声增强,肝内外胆管及门脉未见扩张,C组更为明显。A组用药前后剪切波速度差异无统计学意义(P0.05),B组和C组用药后剪切波速度均较用药前增加(P0.05),用药后B组和C组剪切波速度均高于A组(P0.05)。A组用药后肝细胞病理结果未见明显异常,B组用药后有不同程度肝细胞水肿变性、点状坏死、少许脂肪变性、汇管区血管扩张、淋巴细胞浸润等,C组用药后出现除B组所见的病理损害、较多的脂肪变性外,还可见肝细胞气球样变,肝细胞片状坏死及局灶钙化,局灶性纤维组织增生等。结论:(1)化疗药引起的兔肝细胞的肿胀、脂肪变性、汇管区炎症反应、小血管充血、局部纤维化及钙化等病理改变是肝脏超声图像异常改变的基础。(2)应用中短期化疗药不能引起兔肝明显的脂肪肝病理损害,ARFI可对化疗药物性肝损害进行定量评价。(3)化疗期间高脂饮食可造成兔肝细胞明显脂肪变性。
[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.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R575

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