320排CT灌注成像评价兔下肢急性缺血再灌注损伤的应用价值

发布时间：2018-08-06 08:08

【摘要】：目的：观察兔下肢急性缺血再灌注损伤（I/R）模型CT灌注参数的演变规律，结合相应实验室生化指标（CK、LDH、MDA、SOD），探讨CT灌注成像对兔骨骼肌急性缺血再灌注损伤的诊断价值，为临床应用CT灌注成像评价下肢缺血再灌注损伤情况及治疗提供实验参考。方法：将30只新西兰大白兔随机分成缺血再灌注(I/R)组与假手术组，I/R组又分为再灌注0h、6h、12h、24h亚组，每组6只。I/R各亚组分别在右下肢缺血3h后恢复血流灌注0h、6h、12h、24h时间点接受双下肢CT灌注扫描并采血，得到CT灌注值血流量（AF）、血容量（BV）、对比剂清除率（Clearance），计算右下肢与左下肢各灌注参数的比值即rAF、rBV、rC，并抽血测定血清CK、LDH、MDA、SOD，最后分别行rAF、rBV、rC与生化指标间的相关性分析。结果： ①与假手术组比较， I/R各亚组在0h、6h、12h、24h的rAF均值分别为0.92±0.14、0.89±0.12、0.88±0.20、0.75±0.11，随再灌注时间延长逐渐降低（F=6.206，P值0.05）； ②I/R各亚组血清CK、LDH及MDA值显著高于假手术组（P均0.05），而SOD值随再灌注时间延长逐渐降低（P0.05）； ③rAF与LDH、CK、MDA、SOD的相关系数分别为：-0.644、-0.468、-0.684、0.589（P0.05），但rBV仅与LDH存在显著相关性（r=-0.447，P0.05）。结论： ①血清生化指标证实兔股后侧肌群缺血3小时后再灌注开始即刻就出现损伤，且随着再灌注时间延长加重； ②应用320排CT灌注成像获得兔下肢骨骼肌灌注参数值，，能够半定量地反映兔缺血骨骼肌随再灌注时间推移的损伤情况，即随再灌注时间延长损伤逐渐加重； ③rAF较rBV、rC更好、更早地反映兔骨骼肌再灌注损伤情况；这为临床上应用CT灌注成像评估骨骼肌缺血再灌注损伤情况，确定治疗方案提供新的指导方法。
[Abstract]:Objective: to observe the changes of CT perfusion parameters in rabbit lower extremity acute ischemia-reperfusion injury (I / R) model, and to explore the diagnostic value of CT perfusion imaging in acute ischemia reperfusion injury of rabbit skeletal muscle. To provide experimental reference for clinical evaluation and treatment of lower limb ischemia reperfusion injury by CT perfusion imaging. Methods: thirty New Zealand white rabbits were randomly divided into ischemia reperfusion (I / R) group and sham operation group (I / R group). Six rats in each group received CT perfusion scanning and blood samples were collected at the time points of 0 h, 6 h, 12 h and 24 h after ischemia of the right lower extremity, respectively, at the time point of 0 h, 6 h and 12 h and 24 h after ischemia in the right lower extremity. The ratio of perfusion parameters of right lower extremity to left lower extremity was calculated by (BV), clearance rate of (AF), blood volume contrast medium clearance rate (Clearance),) of CT perfusion value, and the serum CKD was measured. Finally, the correlation between rAFG rBVV rC and biochemical indexes was analyzed. Results: 1Compared with the sham-operated group, the mean rAF of each subgroup of I / R was 0.92 卤0.14 ~ 0.89 卤0.12 卤0.88 卤0.20 卤0.75 卤0.11 at 0 ~ 6 h and 12 h ~ (-1), respectively, which decreased gradually with the prolongation of reperfusion time (P < 0.05). The levels of serum CKT LDH and MDA in 2I/R subgroup were significantly higher than those in sham operation group (P 0.05), but the SOD values decreased gradually with the reperfusion time (P0.05), and the correlation coefficients between 3rAF and 3rAF were 0.6444-0.468 (-0.684) (P0.05), but rBV was only significantly correlated with LDH (r _ (-0.447) P _ (0.05). Conclusion: 1 the serum biochemical indexes confirmed that the injury occurred immediately after reperfusion 3 hours after ischemia, and increased with the prolongation of reperfusion time. (2) the perfusion parameters of rabbit lower limb skeletal muscle were obtained by 320-slice CT perfusion imaging, which can reflect the injury of ischemic skeletal muscle with reperfusion time, that is, the injury increases gradually with the prolongation of reperfusion time. 3rAF is better than rBV rC and reflects the skeletal muscle reperfusion injury earlier, which provides a new method for clinical evaluation of skeletal muscle ischemia-reperfusion injury by CT perfusion imaging.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R543;R816.2

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