慢性丙型肝炎、肝硬化的磁共振波谱研究及应用波谱成像评估抗病毒治疗的疗效

发布时间：2018-04-24 06:55

本文选题：慢性丙型肝炎 + 肝硬化　；参考：《吉林大学》2014年博士论文

【摘要】：目的: 探讨慢性丙型肝炎、丙型肝炎所致肝硬化的磁共振波谱代谢产物的变化及利用有价值的变化评估慢性丙型肝炎、丙型肝炎所致肝硬化抗病毒治疗的疗效。方法: 1、有肝穿结果的丙型肝炎及丙型肝炎所致肝硬化患者45例（经入选标准及排除标准选择后），分别行3.0T磁共振1H-MRS及31P-MRS扫描。1H-MRS研究中将患者分为无脂肪肝组、轻度脂肪肝组、中度脂肪肝组及重度脂肪肝组。重建1H-MRS谱线获得水峰峰值、水峰峰下面积、脂峰峰值、脂峰峰下面积，根据以上数据，计算出水峰和脂峰的波峰值之比、波峰下面积之比。与病理比较，分析以上参数是否具有统计学意义。31P-MRS研究中将患者分为轻度肝炎组、中度肝炎组、肝硬化组，15例健康志愿者作为对照组，重建31P-MRS的波谱曲线，获得从左到右PE、PC、Pi、GPE、GPC、γ-ATP、α-ATP、β-ATP曲线，根据各自峰下面积计算峰下面积百分含量。与病理比较，分析以上参数是否具有统计学意义。 2、将54慢性丙型肝炎、丙型肝炎所致肝硬化患者（经入选标准及排除标准选择后）在接受抗病毒治疗前、治疗6个月后分别进行1H-MRS及31P MRS成像。分别分析1H-MRS中水峰峰值、水峰峰下面积、脂峰峰值、脂峰峰下面积，水峰和脂峰的波峰值之比、波峰下面积之比的变化。及31P-MRS的代谢产物（PE+PC）/（GPE+GPC）变化。结果: 1、45例有肝穿结果的患者中，1例1H-MRS未成功，44例成功病例中脂峰、脂峰峰下面积在无脂肪肝组与中度脂肪肝组之间、无脂肪肝组与重度脂肪肝组之间以及轻度脂肪肝组与中度脂肪肝组之间、轻度脂肪肝与重度脂肪肝组之间、中度脂肪肝与重度脂肪肝组比较差异均有统计学意义(P0．05)，无脂肪肝组与轻度脂肪肝组之间差异无统计学意义(P0．05)。脂/水峰值比、脂/水峰下面积比各组间均具有统计学意义(P0．05)。6例31P MRS未成功，39例成功病例中(PC+PE)％及（PC+PE）/（GPC+GPE）各组间均具有统计学意义（P0．05)，(PC+PE)/(GPC+GPE)差异具有显著统计学意义。 2、54慢性丙型肝炎、丙型肝炎所致肝硬化患者在接受抗病毒治疗前、治疗6个月后脂质的峰值、脂质的峰下面积、脂/水峰值比和脂/水峰下面积比比较，对照组和治疗组治疗前无统计学意义(P0．05)，治疗后有统计学意义（P0．05)，对照组治疗前后无统计学意义(P0．05)，治疗组治疗前后有统计学意义（P0．05)。（PC+PE）/（GPC+GPE）比值在治疗组抗病毒6月后较治疗前显著降低，具有统计学意义（P0．05)，在对照组没有明显变化。在抗病毒治疗应答组，（PC+PE）/（GPC+GPE）明显下降，病毒学无应答组，，（PC+PE）/（GPC+GPE）比值类似于治疗前水平。结论：磁共振波谱可以用来提供肝细胞代谢水平的信息。1H-MRS可以定量评估脂肪沉积程度，31P-MRS可以准确反映丙型肝炎、丙型肝炎所致肝硬化肝纤维化的严重程度。应用1H-MRS及31P-MRS可以作为慢性丙型肝炎患者抗病毒治疗疗效及脂肪沉积程度的指标。
[Abstract]:Objective: To investigate the changes of magnetic resonance spectrum metabolites in patients with chronic hepatitis C and cirrhosis caused by hepatitis C and to evaluate the efficacy of antiviral therapy for cirrhosis caused by chronic hepatitis C and hepatitis C by using the valuable changes. Methods: 1. 45 patients with liver cirrhosis caused by hepatitis C and hepatitis C were divided into 3. 0T Mr 1H-MRS and 31P-MRS. 1H-MRS study. The patients were divided into two groups: non fatty liver group and mild fatty liver group. Moderate fatty liver group and severe fatty liver group. The water peak, the area under the water peak, the area under the lipid peak and the area under the lipid peak are obtained by reconstructing the 1H-MRS spectral line. According to the above data, the ratio of the water peak to the lipid peak wave peak and the ratio of the area under the wave peak are calculated. Compared with pathology, the patients were divided into mild hepatitis group, moderate hepatitis group, liver cirrhosis group and 15 healthy volunteers as control group in the study of 31P-MRS to reconstruct the spectral curve of 31P-MRS. The curves of GPC, 纬 -ATPase, 伪 -ATPase and 尾 -ATP were obtained from left to right PEPEC. The percentage of area under the peak was calculated according to the area under each peak. Compared with pathology, the above parameters were statistically significant. (2) 54 patients with chronic hepatitis C and hepatitis C cirrhosis (selected by inclusion criteria and exclusion criteria) were examined with 1H-MRS and 31P MRS respectively before and after 6 months of antiviral therapy. The changes of water peak, water peak area, lipid peak area, lipid peak area, the ratio of water peak to lipid peak, and the ratio of water peak to lipid peak were analyzed respectively in 1H-MRS. And the metabolite of 31P-MRS, PE PC)/(GPE GPC. Results: 1An out of 45 patients with liver puncture results, 1 case with 1H-MRS was unsuccessful in 44 cases, and the area under the peak was between the non-fatty liver group and the moderate fatty liver group, and the subpeak area of the fat peak was between the non-fatty liver group and the moderate fatty liver group. There was no fatty liver group and severe fatty liver group, between mild fatty liver group and moderate fatty liver group, between mild fatty liver group and severe fatty liver group, between mild fatty liver group and moderate fatty liver group, and between mild fatty liver group and severe fatty liver group. There was significant difference between moderate fatty liver group and severe fatty liver group, but there was no significant difference between non-fatty liver group and mild fatty liver group. The ratio of lipid to water peak value and the area ratio under lipid / water peak were statistically significant in 39 successful cases of 31P MRS. There were significant differences in PC PEI% and PC PE)/(GPC PE)/(GPC among the three groups. 2the peak value of lipid, the area under peak lipid, the ratio of lipid / water peak and the ratio of lipid / water peak area to lipid / water peak area in patients with chronic hepatitis C and cirrhosis caused by hepatitis C were compared after 6 months of antiviral therapy. There was no statistical significance before treatment in control group and treatment group, but there was statistical significance after treatment. In control group, there was no statistical significance before and after treatment. In treatment group, there was statistical significance before and after treatment. The ratio of PC PE)/(GPC before and after treatment in treatment group was higher than that in treatment group 6 months after treatment. Significantly decreased before treatment, There was no significant change in the control group (P 0.05). In the antiviral response group, the PC PE)/(GPC GPEs decreased significantly, and the ratio of PC PE)/(GPC GPEs in the virological non-response group was similar to the pre-treatment level. Conclusion: Magnetic resonance spectroscopy can be used to provide information on the metabolic level of hepatocytes. 1H-MRS can quantitatively evaluate the degree of fat deposition. 31P-MRS can accurately reflect the severity of liver fibrosis caused by hepatitis C and liver cirrhosis caused by hepatitis C. The application of 1H-MRS and 31P-MRS can be used as an index of antiviral effect and fat deposition in patients with chronic hepatitis C.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R512.62;R575.2

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