不同99m Tc-EHIDA SPECT肝胆动态延迟显像特征的胆汁淤积患儿的肝损害情况  

Conditions of liver injury of cholestasic infants with different characteristics of dynamic delayed hepatobiliary imaging using 99mTc-EHIDA in SPECT

作　　者：罗章伟 刘炎富 莫海艺[2] 吕昌恒[2] 黄月艳[2] 林敏华[2] 陆进[2] 黄霞[2] LUO Zhang-wei;LIU Yan-fu;MO Hai-yi;LYU Chang-heng;HUANG Yue-yan;LIN Min-hua;LU Jin;HUANG Xia(Department of Nuclear Medicine,the First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China;Department of Nuclear Medicine,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,China)

机构地区：[1]广西中医药大学第一附属医院核医学科,南宁市530023 [2]右江民族医学院附属医院核医学科,广西百色市533000

出　　处：《广西医学》2020年第22期2930-2933,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2015093)。

摘　　要：目的比较不同99m Tc-二乙基乙酰苯胺亚氨二醋酸(EHIDA)单光子发射型计算机断层成像术(SPECT)肝胆动态延迟显像特征的胆汁淤积患儿的肝损害情况。方法将72例99m Tc-EHIDA SPECT肝胆动态延迟显像肠道均不显影的胆汁淤积患儿,根据肝脏显像清晰度分为观察组34例(肝脏显像逐渐变淡或模糊)和对照组38例(肝脏显像一直较清晰)。比较两组总胆红素、直接胆红素(DBIL)、间接胆红素(IBIL)、血清总胆汁酸、ALT、AST、γ-谷氨酰转移酶(GGT)及ALP、Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白及透明质酸的水平。结果(1)观察组DBIL和总胆汁酸水平高于对照组,IBIL水平低于对照组(均P<0.05)。(2)观察组ALT、AST水平高于对照组(P<0.05)。(3)观察组Ⅲ型前胶原、Ⅳ型胶原、层粘连蛋白和透明质酸水平高于对照组(P<0.05)。结论99m Tc-EHIDA SPECT肝胆动态延迟显像肠道未出现放射性影像的胆汁淤积患儿中,肝脏显像由比较清晰逐渐变淡或模糊者的肝功能损害较肝脏显像清晰者严重。99m Tc-EHIDA SPECT肝胆动态延迟影像特征或可作为婴儿胆汁淤积患儿临床分型的参考依据。Objective To compare the conditions of liver injury of cholestasic infants with different characteristics of dynamic delayed hepatobiliary imaging using 99m Tc-labelled diethyl acetanilide iminodiacetic acid(EHIDA)in single-photon emission computed tomography(SPECT).Methods Seventy-two cholestasic infants,who did not develop images by 99m Tc-EHIDA SPECT dynamic delayed hepatobiliary imaging,were assigned to observation group(34 cases with gradually weakened or blurred liver images)or control group(38 cases with relatively clear liver images constantly)according to the resolution of liver images.The levels of total bilirubin,direct bilirubin(DBIL),indirect bilirubin(IBIL),serum total bile acid,ALT,AST,gamma-glutamyltransferase(GGT),ALP,procollagen type Ⅲ,collagen type Ⅳ,laminin and hyaluronic acid were compared between the two groups.Results(1)The observation group exhibited higher DBIL and total bile acid levels and lower IBIL level as compared with the control group(all P<0.05).(2)The levels of ALT and AST in the observation group were higher than those in the control group(P<0.05).(3)The observation group reported higher levels of procollagen type Ⅲ,collagen type Ⅳ,laminin and hyaluronic acid than the control group(P<0.01).Conclusion Among cholestasic infants who have no radiographic images of the intestinal tract on 99m Tc-EHIDA SPECT dynamic delayed hepatobiliary imaging,those with liver images which are relatively clear initially and then become bleached or blurred gradually suffer more severer liver injury than those with clear liver images.The features of dynamic delayed hepatobiliary imaging using 99m Tc-EHIDA in SPECT may act as a reference for the clinical classification of infants with cholestasis.

关 键 词：婴儿胆汁淤积 婴儿胆道闭锁 放射性核素显像 单光子发射型计算机断层成像术 99m Tc-二乙基乙酰苯胺亚氨二醋酸 肝损害 

分 类 号：R725.75[医药卫生—儿科]