声辐射力脉冲成像对肝硬化兔肝缺血再灌注损伤的诊断价值

发布时间：2018-05-12 03:45

本文选题：肝硬化 + 微循环障碍　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:肝脏缺血再灌注损伤(hepatic ischemia reperfusion injury,IRI)是导致慢性肝纤维化相关肝病患者行肝部分切除术或肝脏移植术后肝功能衰竭的主要原因之一,如何无创性监测并预防肝脏IRI有助于提高手术安全系数。本文旨在探讨声脉冲辐射力成像(Acoustic radiation force impulse,ARFI)技术对合并慢性肝纤维化实验兔肝脏缺血再灌注的诊断价值。材料和方法:采用给予健康成年新西兰兔腹腔内注射由CCL4与橄榄油按1:1配成的50%CCL4-橄榄油溶液0.3ml/kg的方式制作肝硬化模型,选用45只成功制成肝硬化模型的新西兰兔随机分为三组:假手术组(A组,n=15)、肝门阻断组(B组,n=15)、肝门阻断加左半肝切除组(C组,n=15)。假手术组(A组):开腹30min后关闭腹腔;B组:阻断第一肝门30min后重新恢复入肝血流;C组:在B组的基础上同时切除左半肝。建模完成后三组肝硬化兔分别运用ARFI技术于肝门阻断前、肝门阻断30min后再灌注0h、1h、6h、24h和48h六个时间点测量实验兔肝右叶实质相同部位的肝组织剪切波速度SWV,同时检测血清天冬氨酸氨基转移酶(AST)、丙氨酸基转移酶(ALT)的水平评估肝功能。将各个时间点切取的肝组织标本经10%甲醛液固定、HE染色后光镜下观察病理改变,并计算组织形态学总积分。数据分析采取ANOVA进行统计分析,不同区组内两两对照采用随机区组方差分析,ARFI测值SWV与血清ALT、AST水平和组织形态学积分的相关性应用pearson相关分析;P0.05作为差异有显著意义的检验标准。结果:A组再灌注0h、再灌注1h、再灌注6h及再灌注24h四个时相的AFRI测值SWV、血清AST、ALT水平与缺血前的相比,差异无统计学意义(P0.05),B组和C组两组在再灌注早期0h和1h的ARFI测值分别与其术前的相比,差异均具有统计学意义(P0.05),而其ALT、AST水平仅在再灌注后1h升高,与术前和再灌注后0h相比,差异具有统计学意义(P0.05),此时B组和C组实验兔肝细胞的病理学表现为肝细胞水肿,肝板变窄和少量炎性细胞浸润,造成肝窦阻塞现象,提示缺血再灌注早期,肝血流恢复后造成肝微循环功能的损伤。在缺血再灌注6h时,B组和C组AFRI测值SWV、血清AST、ALT水平进一步升高,病理表现为肝细胞水肿加重呈气球样变性。在24h和48h时AFRI测值SWV、血清AST、ALT水平持续升高,在24h达最高峰,持续的缺血损伤最终导致肝细胞变性坏死,细胞萎缩,肝窦塌陷。从再灌注后0h至24h肝组织标本的组织形态学评分随着再灌注时间的延长逐渐升高,两两比较,差异具有统计学意义(P0.05)。B、C组AFRI测值SWV在肝缺血再灌注后的各个时间点与肝组织的病理改变一致,pearson相关性分析显示AFRI测值SWV与血清ALT、AST水平、病理组织形态学积分呈显著正相关(P0.05)。结论:ARFI可以动态的无创性监测肝硬化兔肝脏IRI中的微循环障碍及组织缺血再灌注损伤程度,为临床评估HIRI提供理论依据。
[Abstract]:Objective: hepatic ischemia reperfusion injury is one of the main causes of liver failure after partial hepatectomy or liver transplantation in patients with chronic hepatic fibrosis. How to non-invasive monitoring and preventing liver IRI is helpful to improve the safety factor of operation. The purpose of this study was to evaluate the diagnostic value of acoustic pulse radiography with acoustic radiation force impulse imaging (ARFI) in the diagnosis of hepatic ischemia and reperfusion in rabbits with chronic hepatic fibrosis. Materials and methods: the liver cirrhosis model was established by intraperitoneal injection of CCL4 and olive oil with 50L4 olive oil solution 0.3ml/kg, which was made up of 1:1 in healthy adult New Zealand rabbits. Forty-five New Zealand rabbits were randomly divided into three groups: sham operation group (group A), hepatic hilus occlusion group (group B), hepatic hilus occlusion group (group C) and left hemihepatectomy group (group C). Group A (sham operation group): group B (closed abdominal cavity after opening 30min): group C: after blocking 30min of the first hepatic hilus, the left half liver was resected simultaneously on the basis of group B. After modeling, three groups of cirrhotic rabbits were treated with ARFI technique before hepatic portal occlusion. The shear wave velocities of liver tissue in the same part of the right lobe of liver were measured at 6 h and 48 h after hepatic hilus occlusion and reperfusion for 0 h, 1 h, 6 h and 48 h, and the serum levels of aspartate aminotransferase (AST) and alanine transferase (alt) were measured to evaluate liver function. The pathological changes were observed under light microscope and the total histomorphology score was calculated after the liver tissue samples were fixed with 10% formaldehyde solution and stained with HE at each time point. ANOVA is used to analyze the data. The correlation between SWV and serum alt AST level and histomorphology score was analyzed by random block ANOVA and pearson correlation analysis (P0.05) was used as the test standard of significant difference. Results compared with those before ischemia, the levels of AFRI were measured at 0 h, 1 h, 6 h and 24 h after reperfusion in group 1: a, and the levels of alt in serum of group A were compared with those before ischemia. There was no significant difference in ARFI values between group B and group C at 0 h and 1 h after reperfusion, and there was significant difference between group B and group C before and after reperfusion, while the level of alt AST increased only 1 h after reperfusion, compared with preoperative and 0 h after reperfusion. The difference was statistically significant (P 0.05). The pathological manifestations of hepatocytes in group B and group C were hepatocyte edema, narrowing of liver plate and infiltration of a few inflammatory cells, which caused hepatic sinusoidal obstruction, suggesting early ischemia reperfusion. Liver microcirculation function is damaged after the recovery of hepatic blood flow. At 6h after ischemia and reperfusion, the AFRI values of group B and group C were measured, and the serum alt level of AST was further increased, and the pathological features were as follows: the edema of hepatocytes was aggravated as balloon degeneration. At 24h and 48h, the level of serum ASTV-alt increased continuously and reached the peak at 24h. The sustained ischemic injury resulted in hepatocyte degeneration and necrosis, cell atrophy and sinusoidal collapse. From 0 h to 24 h after reperfusion, the histomorphologic scores of liver tissue increased with the prolongation of reperfusion time. The difference was statistically significant (P 0.05). The AFRI values of group C were consistent with the pathological changes of liver tissue at different time points after hepatic ischemia-reperfusion. The results of Pearson correlation analysis showed that there was a significant positive correlation between the SWV measured by AFRI and the level of alt AST in serum, and there was a significant positive correlation between the histopathological score and pathological tissue morphology score (P 0.05). Conclusion the microcirculation disturbance and the degree of ischemia reperfusion injury in liver IRI of cirrhotic rabbits can be dynamically monitored by WARFI, which provides a theoretical basis for clinical evaluation of HIRI.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R445.1

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