动态SPECT ^99mTc半乳糖人血清清蛋白显像技术评估硬化肝脏的储备功能  

Assessment of hepatic reserve function of cirrhosis liver using dynamic SPECT 99mTc-galactosyl human serum albumin scintigraphy

作　　者：项灿宏[1] 陈英茂[2] 邵明哲[2] 李灿[2] 刘涵生[1] 张锦明[2] 刘志伟[1] 段伟东[1] 蔡守旺[1] 田嘉禾[2] 董家鸿[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853 [2]解放军总医院核医学科,北京100853

出　　处：《中华外科杂志》2013年第7期592-595,共4页Chinese Journal of Surgery

摘　　要：目的 探讨动态SPECT^99mTc半乳糖人血清清蛋白（GSA）显像技术对硬化肝脏储备功能评估的有效性.方法 对2010年1月至2011年12月55例肝硬化患者进行研究,其中男性43例,女性12例;年龄35 ～ 69岁,平均年龄（51±9）岁.利用SPECT/CT一体机顺次进行CT扫描和^99mTc-GSA动态SPECT扫描,计算全肝和半肝肝实质形态学体积（MLV）、功能学体积（FLV）及肝细胞摄取速率常数（GSA-K）.分析GSA-K与常规生化指标、Child-Pugh评分、吲哚菁绿血浆清除率（ICG-K）等的关系.进一步将患者分为门静脉左支闭塞或狭窄组（组1,5例）、门静脉右支闭塞或狭窄组（组2,13例）和门静脉未受累组（组3,37例）,比较各组MLV和FLV.结果 患者全肝、左半肝、右半肝的FLV分别为（594±152） ml、（244±119） ml、（356±171）ml.GSA-K值与总胆红素、凝血酶原时间、Child-Pugh评分及ICG-K值有相关关系（r=-0.730～-0.298,P＜0.05）.组1的受累侧半肝与对侧半肝的FLV比值及MLV比值分别为0.09±0.06、0.30±0.14,组2为0.57 ±0.43、1.08±0.63,组3为0.71±0.30、0.71 ±0.48.方差分析比较各组间MLV比值与FLV比值的差异有统计学意义（F =22.8,P=0.000）;LSD法两两比较发现,组1和组3之间（P=0.000）、组2和组3之间有明显差异（P =0.000）.结论 动态SPECT99mTc-GSA显像技术不仅可以有效地评估硬化肝脏的全肝功能,更能准确地反映区域肝脏功能的变化.Objective To evaluate the effectiveness of dynamic SPECT 99mTc-galactosyl human serum albumin （GSA） scintigraphy on the assessment of reserve function of cirrhosis liver. Methods From January 2010 to December 2011, 55 patients with cirrhosis liver were enrolled in this study. The case numbers of male and female were 43 and 12 respectively and the age was （51 _± 9） years （ ranging from 35 to 69 years）. After routine biochemistry test, CT scan and 99＇~Tc-GSA dynamic SPECT scan were performed in turn using a juxtaposed SPECT/CT system. Then the morphologic volume of liver parenchyma （ MLV）, functional liver volume （FLV） and the hepatic cell absorption rate constant （GSA-K） were calculated. The correlations between GSA-K and routine biochemistry test, Child-Pugh score, indocyanine green clearance rate （1CG-K） were analyzed. The patients were further divided into 3 groups according to whether there was occlusion or stenosis in the main branch of left portal vein （ group 1, n = 5）, right portal vein （ group 2, n = 13） or not （group 3, n = 37） and the regional hepatic functions index of the 3 groups were compared. Results The value of FLV of the whole, left and right liver was （594 ± 152） ml, （244 ± 119） ml and （356± 171 ） ml, respectively. There were correlations between GSA-K and total bilirubin,prolhromhintime, Child-Pugh score and ICG-K （ r = - 0. 730- - 0. 298, P 〈 0. 05 ）. The FLV and MLV ratios of involved hemiliver to uninvolved hemiliver were 0. 09 ± 0. 06 and 0. 30 ± 0. 14 in group 1 , 0. 57 ± 0.43 and 1.08 ±0. 63 in group 2, 0. 71 ± 0. 30 and 0. 71±0. 48 in group 3. The difference in MLV-FLV ratio was signifcant hetween group 1 and group 3, between group 2 and group 3 （ P =0. 000）. Conclusions The dynamic SPCECT ^99mTc-GSA scintigraphy can not only assess the whole liver function of cirrhosis liver effectively, but also evaluate the variation of regional liver funetion accurately.

关 键 词：肝硬化 体层摄影术 发射型计算机 单光子 肝疾病 

分 类 号：R575.2[医药卫生—消化系统]