组织结构声学定量技术无创评估TIPS联合PTVE疗效  

Non-invasive evaluation on therapeutic effect of transjugular intrahepatic portosystemic shunt and percutaneous transhepatic varices embolization using acoustic structure quantification method

作　　者：郑晓[1] 李思杰[2] 郭大静[3] 张萍[1] 冉海涛[1] 王志刚[1] 郑元义[1] 左国庆[4] 

机构地区：[1]重庆医科大学超声影像学研究所,重庆400010 [2]重庆市渝中区疾病预防控制中心传染病防治科,重庆400010 [3]重庆医科大学附属第二医院放射科,重庆400010 [4]重庆医科大学附属第二医院消化内科,重庆400010

出　　处：《重庆医科大学学报》2015年第8期1129-1133,共5页Journal of Chongqing Medical University

基　　金：国家自然科学基金资助项目(编号:81271598;81270021);教育部科学技术研究重点资助项目(编号:[2012]76);重庆市教委科学技术研究重点资助项目(编号:KJ120328);重庆市杰出青年基金资助项目(编号:cstc2013jcyjjq10004)

摘　　要：目的:探讨组织结构声学定量分析(acoustic structure quantification,ASQ)技术在无创评价经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)联合经皮肝穿胃冠状静脉栓塞术(percutaneous transhepatic varices embolization,PTVE)疗效的临床应用价值。方法:应用ASQ技术对30例正常人及30例肝硬化门静脉高压预行TIPS联合PTVE患者手术前后肝、脾分别定量分析,比较手术前后肝、脾的ASQ卡方值直方图和ASQ定量相关参数:众数、均值、标准差以及蓝红2色直方图曲线下面积比;并在手术过程中测量门静脉压(portosystemic pressure gradient,PPG);比较手术前后肝、脾ASQ定量参数值的变化及与PPG的相关性。结果:PPG术前组(28.71±4.81)mm Hg与术后组(18.30±4.73)mm Hg比较,差异具有统计学意义(P<0.05);脾脏Red Mode、Red Ave、Red SD、FD ratio、Blue Mode、Blue Ave、Blue SD各参数值正常对照组分别为(99.60±2.15)、(102.25±2.22)、(13.62±1.70)、(0.13±0.11)、(120.90±6.29)、(132.57±15.98)、(27.94±13.65),术前组上述参数值分别为(103.21±1.98)、(107.52±2.51)、(18.48±1.41)、(0.18±0.07)、(125.25±2.86)、(146.57±9.03)、(37.64±10.21),术前组脾ASQ各定量参数均大于正常对照组(P<0.05);术后组脾ASQ各定量参数分别为(101.66±1.97)、(105.24±2.04)、(16.56±1.49)、(0.15±0.09)、(122.96±5.56)、(137.96±14.46)、(31.45±12.49),术后各参数值均小于术前,各组之间具有统计学差异(P<0.05);肝ASQ各定量参数值在术前组分别为(117.81±3.23)、(120.70±3.27)、(19.70±1.07)、(0.67±0.28)、(136.05±4.62)、(148.68±7.03)、(33.68±7.36),术后组各参数值分别为(118.01±3.35)、(120.9±3.58)、(19.54±1.40)、(0.66±0.30)、(135.26±4.38)、(148.42±7.65)、(33.73±6.30),术前组与术后组比较差异无统计学意义(P>0.05)。脾ASQ各定量参数值与PPG呈高度正相关(r值分别为0.299、0.331、0.451、0.848、0.961、0.318、0.881,P均<0.05);然而肝ASQ各定量参数值Objective：To explore the diagnostic value of acoustic structure quantification（ASQ）technique in noninvasive assessment of transjugular intrahepatic portosystemic stent（TIPS）and percutaneous transhepatic varices embolization（PTVE）. Methods：Quantitative assessment of 30 normal subjects and 30 patients who underwent TIPS and PTVE for treatment of portal hypertension（PHTN）was held by ASQ. The portal vein pressure was measured while placing the TIPS and PTVE. ASQ parameters of the plural,mean,standard deviation,the ratio of blue and red color histogram curve area and the chi-square value were compared. The correlation between ASQ parameters of the spleen and the liver and portal venous pressure was analyzed. Results：There were significant differences in portal vein pressure pre and post TIPS and PTVE（P〈0.05）. ASQ quantitative parameters were Red Mode,Red Ave,Red SD,FD ratio,Blue Mode,Blue Ave,Blue SD. The values of ASQ quantitative parameters of the spleen were higher in PHTN pre TIPS and PTVE group than in health control group（P〈0.05）. The values of ASQ quantitative parameters of the spleen were higher in PHTN pre TIPS and PTVE group than in post TIPS and PTVE group（P〈0.05）. There was no difference in values of ASQ quantitative parameters of the live pre and post TIPS and PTVE（P〈0.05）. Significant linear correlation was found between the ASQ quantitative parameters of the spleen and portal vein pressure（r=0.299,0.331,0.451,0.848,0.961,0.318 and 0.881,all P〈0.05）. But the ASQ quantitative parameters of liver were not correlated with the portal venous pressure（r=0.194,0.174,0.045,0.169,0.128,0.105 and 0.136,all P〈0.05）. There were significant differences in spleen index between healthy subjects and patients with PHTN（P〈0.05）,as well as between pre and post TIPS and PTVE（P〈0.05）. Conclusion：The ASQ quantitative parameters of the spleen could be used as non-invasive method for quantitatively monitoring the change of portal vein pressure pre and post

关 键 词：经颈静脉肝内门体分流术 经皮肝穿胃冠状静脉栓塞术 组织结构声学定量 

分 类 号：R445.1[医药卫生—影像医学与核医学]