CAJ | 학술논문

目的：通过多层螺旋CT肝脏灌注成像探讨在不同海拔高度正常成人肝脏血流灌注及体积的变化，以评估正常人肝脏在缺氧状态下的灌注状态，为肝脏疾病的诊断及治疗提供依据。资料与方法60例志愿者按海拔高度分为3组：A组22例来自海拔2260~3100 m，B组20例海拔3260~4100 m，C组18例海拔4260~5260 m，以肝门区为中心，绘制感兴趣区时间-密度曲线，采用去卷积法计算肝动脉灌注量（HAP）、门静脉灌注量（PVP）、肝脏总灌注量（TLP）、肝动脉灌注指数（HPI）；采用点圈法人工测量肝脏体积。结果 A、B、C组HAP分别为（10.50±3.62）ml/（100 ml · min）、（15.03±4.27）ml/（100 ml · min）、（18.39±7.20）ml/（100 ml · min），其中A组与C组差异有统计学意义（P<0.05）；3组PVP分别为（138.78±14.29） ml/（100 ml · min）、（80.42±16.80）ml/（100 ml · min）、（63.78±7.79）ml/（100 ml·min），两两比较差异均有统计学意义（P<0.05）；3组TLP分别为（149.30±15.55） ml/（100 ml · min）、（95.57±18.75）ml/（100 ml · min）、（82.19±10.56）ml/（100 ml · min），两两比较差异均有统计学意义（P<0.05）；3组HPI分别为7.00±2.17、16.27±4.22、22.05±7.90，两两比较差异均有统计学意义（P<0.05）。3组肝脏体积分别为（1173.5±155.2）cm3、（1282.9±362.2）cm3、（1525.4±352.2）cm3，其中A组与C组差异有统计学意义（P<0.05）。结论海拔高度直接影响肝脏的血流灌注，随着海拔增高，HAP、HPI逐渐升高，PVP、TLP逐渐降低，肝脏体积逐渐增大，提示高原低氧环境对肝脏有一定的损伤。多层螺旋CT肝脏灌注成像可以反映肝组织的血流动力学变化，有助于肝脏疾病的诊断及治疗。
목적：통과다층라선CT간장관주성상탐토재불동해발고도정상성인간장혈류관주급체적적변화，이평고정상인간장재결양상태하적관주상태，위간장질병적진단급치료제공의거。자료여방법60례지원자안해발고도분위3조：A조22례래자해발2260~3100 m，B조20례해발3260~4100 m，C조18례해발4260~5260 m，이간문구위중심，회제감흥취구시간-밀도곡선，채용거권적법계산간동맥관주량（HAP）、문정맥관주량（PVP）、간장총관주량（TLP）、간동맥관주지수（HPI）；채용점권법인공측량간장체적。결과 A、B、C조HAP분별위（10.50±3.62）ml/（100 ml · min）、（15.03±4.27）ml/（100 ml · min）、（18.39±7.20）ml/（100 ml · min），기중A조여C조차이유통계학의의（P<0.05）；3조PVP분별위（138.78±14.29） ml/（100 ml · min）、（80.42±16.80）ml/（100 ml · min）、（63.78±7.79）ml/（100 ml·min），량량비교차이균유통계학의의（P<0.05）；3조TLP분별위（149.30±15.55） ml/（100 ml · min）、（95.57±18.75）ml/（100 ml · min）、（82.19±10.56）ml/（100 ml · min），량량비교차이균유통계학의의（P<0.05）；3조HPI분별위7.00±2.17、16.27±4.22、22.05±7.90，량량비교차이균유통계학의의（P<0.05）。3조간장체적분별위（1173.5±155.2）cm3、（1282.9±362.2）cm3、（1525.4±352.2）cm3，기중A조여C조차이유통계학의의（P<0.05）。결론해발고도직접영향간장적혈류관주，수착해발증고，HAP、HPI축점승고，PVP、TLP축점강저，간장체적축점증대，제시고원저양배경대간장유일정적손상。다층라선CT간장관주성상가이반영간조직적혈류동역학변화，유조우간장질병적진단급치료。
Purpose Changes of hepatic perfusion and volume of normal adults living at different altitudes are investigated with hepatic perfusion imaging using multi-slice spiral CT to explore the perfusion status of normal human liver in hypoxia condition, and to provide the basis for the diagnosis and treatment of liver diseases. Materials and Methods Sixty volunteers were divided into three groups according to altitude:22 cases in group A with altitude from 2260 to 3100 meters, 20 cases in group B with altitude from 3260 to 4100 meters, and 18 cases in group C with altitude from 4260 to 5260 meters, time-density curves within the ROI was drawn with hepatic hilar region as the center, and hepatic artery perfusion (HAP), portal vein perfusion (PVP), total hepatic perfusion (TLP), hepatic arterial perfusion index (HPI) were calculated using deconvolution method;and point circle method was used to measure the volume of liver manually. Results HAP of group A, B, C were (10.50±3.62) ml/(100 ml · min), (15.03±4.27) ml/(100 ml · min) and (18.39±7.20) ml/(100 ml · min) respectively, and there was significant difference between group A and group C (P<0.05);PVP of three groups were (138.78±14.29) ml/(100 ml · min), (80.42±16.80) ml/(100 ml · min), and (63.78±7.79) ml/(100 ml · min) respectively, signiifcant differences (P<0.05) can be detected for the comparison between each two of them; TLP of the three groups were (149.30±15.55) ml/(100 ml · min), (95.57±18.75) ml/(100 ml · min) and (82.19±10.56) ml/(100 ml · min) respectively, statistically signiifcant differences (P<0.05) can also be found for the comparison between each two of them. HPI of the three groups were 7.00±2.17, 16.27±4.22 and 22.05±7.90 respectively, statistically signiifcant differences (P<0.05) were observed for the comparison between each two of them;liver volume of the three groups were (1173.5±155.2) cm3, (1282.9±362.2) cm3 and (1525.4±352.2) cm3, difference between group A and group C was statistically signiifcant (P<0.05). Conclusion Liver perfusion can be affected by altitude, with the altitude increasing, HAP and HPI will also raise gradually, while PVP and TLP will decrease accordingly, indicating that hypoxia environment due to high altitude will do certain damage on the liver. MSCT perfusion imaging is able to relfect the hemodynamic changes of liver, thus is useful in clinical diagnosis and treatment of liver diseases.