肝缺血再灌注损伤血流动力学的CT灌注评价  

Evaluation of CT perfusion imaging for the hemodynamics on liver ischemia reperfusion injury

作　　者：李家平[1] 黄勇慧[1] 李鹤平[1] 王于[1] 谭国胜[1] 陈伟[1] 杨建勇[1] 

机构地区：[1]中山大学附属第一医院介入放射科,广州510080

出　　处：《中华放射学杂志》2009年第8期878-881,共4页Chinese Journal of Radiology

基　　金：国家自然科学基金资助项目（30270417）;广东省科技计划项目（B36003002）

摘　　要：目的探讨CT灌注成像（CTPI）在肝缺血再灌注损伤（IR）中的应用价值。方法采用数字表法随机将21只成年犬分成3组：对照组（CON组）、静脉用药组（IV组）和肠系膜上动脉用药组（SMA组），每组7只，建立动物IR模型，肝门阻断45min后再灌注60min。IV组和SMA组每只犬肝门阻断前5min和再灌注60min后各推注前列地尔脂微球（Lipo—PGE1）1次；CON组每只犬肝门阻断前5min和再灌注60min后各缓慢推注生理盐水（NS）1次。各组首次用药或NS前30min及再次用药或NS后30min依次行CTPI、门静脉测压和病理取材，对比分析IR前后肝血流灌注量、门静脉自由压（FPP）和病理学的变化。IR前后各肝血流灌注参数和FPP的自身比较采用配对t检验，各肝血流灌注参数差值的组间比较采用单因素方差分析。结果（1）IR建立后各组肝血流灌注量均有不同程度的减少，其中CON组肝动脉灌注量、门静脉灌注量、肝总灌注量IR建立前后的差值分别为（0．091±0．028）、（0．149±0．011）和（0．239±0．038）ml·min^-1·ml^-1，IV组的差值分别为（0．053±0．013）、（0．117±0．000）和（0．171±0．012）ml·min^-1·ml^-1，SMA组的差值分别为（0．043±0．015）、（0．104±0．005）和（0．147±0．021）ml·min^-1·ml^-1，各组上述参数的组问比较差异均有统计学意义（F值分别为5．286、2．894和4．705，P值均〈0．05），其中IR建立后CON组的肝各灌注量减少幅度最大，而SMA组的变化最轻，IV组的变化介于两者之间。（2）CON组、SMA组、IV组IR前的FPP分别为（5．73±0．89）、（5．86±1．17）、（5．57±0．61）nlmHg（1mmHg=0．133kPa），IR后的FPP分别为（7．35±1．05）、（6．10±1．33）、（6．05±0．82）mmHg，与IR前相比，IR后CON组的FPP升高（t=-2．666，P〈0．05），而SMA组、IV组的FPP变化不显著（t值分别为-1．369和-1．732，P值均〉0．05）。（Objective To evaluate the value of CT perfusion imaging （CTPI） on liver ischemia reperfusion injury. Methods Twenty-one adult dogs were divided into three groups randomly： CON group, IV group and SMA group, each group consisted of 7 dogs. Under general anesthesia and laparotomy, porta hepatis were occluded for 45 minutes and reperfused 60 minutes later to establish IR injury models. Lipo- PGE1 administration was conducted 5 minutes before porta occlusion and 60 minutes after reperfusion in IV and SMA group, the dosage of Lipo-PGE1 was 1 μg/kg and rate of injection was 0. 05 μg . kg^-1 . min^-1 sodium chloride administration was slowly conducted 5 minutes before porta occlusion and 60 minutes after reperfusion in CON group as control, the rate of injection was 2 ml/kg. CTPI free portal pressure measurement （FPP） and pathological sampling were performed in succession and compared before and after IR. Paired-sample t test was used for self control study on parameters of liver perfusion before and after IR in each group, and One-way ANOVA was used for comparison of different values of each parameter of liver perfusion among groups. Results （ 1 ） Each liver blood perfusion value decreased in different levels after IR. The different values of hepatic arterial perfusion （HAP）, portal vein perfusion （PVP）, total liver perfusion （TLP） before and after IR was （0.091 ±0.028） , （0. 149 ±0.011）, （0.239 ±0.038）ml·min^-1·ml^-1 in CON group, and （0.053 ±0.013）,（0.117± 0.000）,（0.171 ±0.012）ml·min^-1·ml^-1 in IV group, and（0. 043 ±0.015） ,（0. 104 ±0.005） ,（0. 147 ±0.021） ml·min^-1·ml^-1 in SMA group , respectively . There were significant difference in each parameter of liver perfusion among groups （F = 5. 286, 2. 894, 4. 705 ;P 〈 0.05）. The liver perfusion was markedly decreased in the CON group, and moderately decreased in SMA group and mildly decreased in IV group. （2） Before IR, FPP of CON group, SMAgroup, and IV group was （5.73 ±0.89�

关 键 词：缺血再灌注 体层摄影术 X线计算机 灌流 

分 类 号：R686[医药卫生—骨科学]