CT灌注成像技术用于断肢再植骨骼肌再灌注损伤实验性研究  

Experimental study of application of CT perfusion imaging inskeletal muscle reperfusion injury after replantation of severed limbs

作　　者：方武 张弦[1] 王永华[1] 丁波永 FANG Wu;ZHANG Xian;WANG Yonghua;DING Boyong(Author Affiliation:Radiology department,Songgang People’s Hospital,Baoan district,Shenzhen,Guangdong 518105,China)

机构地区：[1]深圳市宝安区松岗人民医院放射科,广东深圳518105

出　　处：《安徽医药》2019年第5期863-866,I0002,共5页Anhui Medical and Pharmaceutical Journal

基　　金：广东省深圳市宝安区科技计划基础研究项目(2017JD171)

摘　　要：目的评价在断肢再植骨骼肌再灌注损伤的评估中应用CT灌注成像技术的效果。方法 2017年7—8月,选择60只SD大鼠,采用随机数字表法分为假手术组和再植组(其中分为夹闭1 h、2 h、4 h和8 h等4个亚组),通过钳夹大鼠左侧股动静脉,建立大鼠左后肢的断肢模型,夹闭左侧股动静脉1 h、2 h、4 h、8 h后恢复血供。应用多排螺旋CT灌注扫描比较各组的血流量(BF)、相对血流量(rBF)、血容量(BV)和相对血容量(rBV)等灌注指标、乳酸脱氢酶(LDH)和肌酸激酶(CK)水平,探究r LDH和CK水平的相关性,并应ROC曲线评价rBF、LDH和CK预测再灌注后肢体坏死的效能差异。结果与假手术组BF(4.08±1.09)mL·(100 g)-1·min-1,rBF 1.03±0.07,BV(4.85±1.21)mL·(100 g)-1,rBV 1.03±0.07,造影剂通过总时间(TT)(38.06±10.11)s,造影剂达峰时间(TTP)(27.54±6.37)s相比,再植组术侧1 h,2 h,4 h,8 h的BF(3.55±1.06),(3.12±0.91),(2.76±0.82),(2.39±0.71)mL·(100 g)-1·min-1、rBF(0.92±0.12),(0.86±0.10),(0.81±0.11),(0.75±0.12)、BV(4.31±1.11),(3.80±0.96),3.31±0.87),(2.89±0.81)mL·(100 g)-1和rBV(0.91±0.11),(0.85±0.11),(0.80±0.10),(0.75±0.09)明显降低(P<0.05),TT(43.21±10.31),(49.03±11.26),(55.23±12.13),(59.41±12.35)s和TTP(31.21±7.31),(35.36±8.26),(39.78±9.13),(44.16±9.35)s明显延长(P<0.05)。与假手术组(160±50)U/L,(120±40)U/L相比,不同时间的再植组的LDH(300±120)U/L,(350±150)U/L,(380±160)U/L,(420±180)U/L和CK(320±140)U/L,(360±150)U/L,(420±160)U/L,(480±170)U/L水平明显升高(P<与LDH(r=-0.710,P<0.001)和CK(r=-0.738,P<0.001)水平呈明显的负相关。受试者工作特征曲线(ROC曲线)显示,应用rBF预测肢体坏死的诊断效能(AUC=0.974)明显高于LDH(AUC=0.724)和CK(AUC=0.754)。结论在断肢再植骨骼肌再灌注损伤的评估中应用CT灌注成像技术具有较高的应用价值。Objective To observe the effect of CT perfusion imaging in the evaluation of skeletal muscle reperfusion injury after replantation.Methods From July 2017 to August 2017,60 SD rats were randomly divided into sham operation group and replantation group(which were divided into four subgroups:1h,2h,4h and 8h).The blood flow was restored after left femoral artery and vein were clipped for 1h,2h,4h and 8h.The blood flow(BF),the relative blood flow(rBF),the blood volume(BV),the relative blood volume(rBV),lactate dehydrogenase(LDH)and creatine kinase(CK)were measured by multi-slice spiral CT perfusion scan.The correlation between rBF and LDH or CK levels was investigated,and the effect of rBF,LDH and CK on limb necrosis after reperfusion were evaluated by receiver operating characteristic curve.Results Compared with the sham group BF(4.08±1.09)mL·(100 g)^-1·min^-1,rBF 1.03±0.07,BV(4.85±1.21)mL·(100 g)^-1,rBV 1.03±0.07,TT(38.06±10.11)s,TTP(27.54±6.37)s,the BF(3.55±1.06),(3.12±0.91),(2.76±0.82),(2.39±0.71)mL·(100 g)^-1·min^-1,rBF(0.92±0.12),(0.86±0.10),(0.81±0.11),(0.75±0.12),,BV(4.31±1.11),(3.80±0.96),3.31±0.87),(2.89±0.81)mL·(100 g)^-1 and rBV(0.91±0.11),(0.85±0.11),(0.80±0.10),(0.75±0.09)were significantly decreased(P<0.05),the TT(43.21±10.31),(49.03±11.26),(55.23±12.13),(59.41±12.35)s and TTP(31.21±7.31),(35.36±8.26),(39.78±9.13),(44.16±9.35)s extended significantly(P<0.05).Compared with the sham group,the levels of LDH and CK in the replantation group were significantly increased(P<0.05).The longer the clipping time,the higher the LDH(300±120)U/L,(350±150)U/L,(380±160)U/L,(420±180)U/L and CK(320±140)U/L,(360±150)U/L,(420±160)U/L,(480±170)U/L levels(P<0.05).Correlation analysis showed a significant negative correlation between rBF and LDH(r=-0.710,P<0.001)and CK(r=-0.738,P<0.001).The receiver operating characteristic curve(ROC)curve showed that the·863·安徽医药Anhui Medical and Pharmaceutical Journal 2019 May,23(5)diagnostic efficacy of rBF in predicting limb necrosis(A

关 键 词：再植术 肌 骨骼 再灌注损伤 灌注成像 体层摄影术 X线计算机 肌酸激酶 乳酸脱氢酶类 血液流变学 

分 类 号：R658.1[医药卫生—外科学] R814[医药卫生—临床医学]