CAJ | 학술논문

目的探讨动态SPECT99mTc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.
목적 탐토동태SPECT99mTc반유당인혈청청단백(GSA)현상기술대경화간장저비공능평고적유효성.방법 대2010년1월지2011년12월55례간경화환자진행연구,기중남성43례,녀성12례;년령35 ～ 69세,평균년령(51±9)세.이용SPECT/CT일체궤순차진행CT소묘화99mTc-GSA동태SPECT소묘,계산전간화반간간실질형태학체적(MLV)、공능학체적(FLV)급간세포섭취속솔상수(GSA-K).분석GSA-K여상규생화지표、Child-Pugh평분、신타정록혈장청제솔(ICG-K)등적관계.진일보장환자분위문정맥좌지폐새혹협착조(조1,5례)、문정맥우지폐새혹협착조(조2,13례)화문정맥미수루조(조3,37례),비교각조MLV화FLV.결과 환자전간、좌반간、우반간적FLV분별위(594±152) ml、(244±119) ml、(356±171)ml.GSA-K치여총담홍소、응혈매원시간、Child-Pugh평분급ICG-K치유상관관계(r=-0.730～-0.298,P＜0.05).조1적수루측반간여대측반간적FLV비치급MLV비치분별위0.09±0.06、0.30±0.14,조2위0.57 ±0.43、1.08±0.63,조3위0.71±0.30、0.71 ±0.48.방차분석비교각조간MLV비치여FLV비치적차이유통계학의의(F =22.8,P=0.000);LSD법량량비교발현,조1화조3지간(P=0.000)、조2화조3지간유명현차이(P =0.000).결론 동태SPECT99mTc-GSA현상기술불부가이유효지평고경화간장적전간공능,경능준학지반영구역간장공능적변화.
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 ease 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 99mTc-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 (ICG-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,prothrombintime,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 between 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 function accurately.