中国医药
中國醫藥
중국의약
China Medicine
2015年
12期
1767-1771
,共5页
孙国超%刘宏霞%杨书峥%韩璐璐%张锡海%张蓓
孫國超%劉宏霞%楊書崢%韓璐璐%張錫海%張蓓
손국초%류굉하%양서쟁%한로로%장석해%장배
慢性乙型肝炎肝硬化%基于Couinaud分段%多层螺旋CT全肝灌注%血流状况评估
慢性乙型肝炎肝硬化%基于Couinaud分段%多層螺鏇CT全肝灌註%血流狀況評估
만성을형간염간경화%기우Couinaud분단%다층라선CT전간관주%혈류상황평고
Chronic hepatitis B cirrhosis%Couinaud segments%Multi-slice spiral computed tomography,whole liver perfusion%Blood flow condition
目的 探讨基于Couinaud分段多层螺旋CT(MSCT)全肝灌注成像对慢性乙型肝炎肝硬化患者血流状况的评估价值.方法 选取2013年1月至2014年1月在山东省滨州市中心医院进行治疗的50例慢性乙型肝炎肝硬化患者为观察组,另选取50名同期来本院进行体检的正常肝脏者为对照组.对所有对象行基于Couinaud分段MSCT全肝灌注成像,测量各段灌注参数,将肝硬化按肝功能Child-pugh分级标准分为A级(23例)、B级(20例)、C级(7例),与正常组肝脏五叶血流灌注参数进行比较.结果 观察组灌注峰值时间较对照组长[主动脉:(15±4)s比(14±3)s,门静脉:(36±8)s比(29±5)s,脾脏:(27±6)s比(23±5)s]、强化峰值较对照组低[主动脉:(266±54) HU比(272±53) HU,门静脉:(81 ±31)HU比(91 ±34)HU,脾脏:(35 ±15)HU比(51 ±23) HU],差异有统计学意义(P＜0.05).观察组Couinaud各段灌注量参数值各不相同,且各段肝动脉灌注量、门静脉灌注量、全肝总灌注量及肝动脉灌注指数参数差异均有统计学意义(均P＜0.05);其中肝脏SⅢ段与SⅦ段每灌注100 ml的肝动脉灌注量值分别为(11±5) ml/min、(10±5)ml/min,二者差异有统计学意义(P＜0.05).肝脏各叶门静脉灌注量与全肝总灌注量在观察组A级、B级、C级患者均低于对照组,差异均有统计学意义[门静脉灌注量:尾状叶(58.3 ±31.2)、(68.7±21.0)、(58.9±30.7)ml/min比(92.7±44.7)ml/min,左外叶(57.6 ±21.0)、(68.3 ±20.8)、(58.5 ±23.8) ml/min比(87.0 ±34.4) ml/min,左内叶(63.5 ±23.2)、(73.2±22.1)、(62.1 ±31.8) ml/min比(84.2±27.3) ml/min,右前叶(69.5 ±28.5)、(70.7 ±28.4)、(70.5±27.5)比(91.8 ±24.1)ml/min,右后叶(56.5 ±16.8)、(68.1 ±25.8)、(57.9±15.8)比(91.6±23.6) ml/min;全肝总灌注量尾状叶:(68.3±21.2)、(78.7±31.0)、(68.9±30.7)ml/min比(102.7±43.7) ml/min,左外叶(67.6±21.0)、(78.3±25.8)、(68.5±30.8)ml/min比(104.0±34.4)ml/min,左内叶(63.5±23.2)、(68.2±22.1)、(72.1±38.8) ml/min比(94.2±27.3) ml/min,有前叶(69.5 ±28.5)、(70.7±28.0)、(70.5±27.5) ml/min比(98.8 ±34.1)ml/min,右后叶(66.5±26.8)、(68.1 ±25.8)、(77.9±35.8)ml/min比(101.6±34.6) ml/min;均P＜0.05];肝动脉灌注量差异无统计学意义(p＞0.05).结论 基于Couinaud分段的血流状态不尽相同,MSCT全肝灌注成像能反映Couinaud各段的血流状态变化,有助于评价肝硬化各级的血流状态.
目的 探討基于Couinaud分段多層螺鏇CT(MSCT)全肝灌註成像對慢性乙型肝炎肝硬化患者血流狀況的評估價值.方法 選取2013年1月至2014年1月在山東省濱州市中心醫院進行治療的50例慢性乙型肝炎肝硬化患者為觀察組,另選取50名同期來本院進行體檢的正常肝髒者為對照組.對所有對象行基于Couinaud分段MSCT全肝灌註成像,測量各段灌註參數,將肝硬化按肝功能Child-pugh分級標準分為A級(23例)、B級(20例)、C級(7例),與正常組肝髒五葉血流灌註參數進行比較.結果 觀察組灌註峰值時間較對照組長[主動脈:(15±4)s比(14±3)s,門靜脈:(36±8)s比(29±5)s,脾髒:(27±6)s比(23±5)s]、彊化峰值較對照組低[主動脈:(266±54) HU比(272±53) HU,門靜脈:(81 ±31)HU比(91 ±34)HU,脾髒:(35 ±15)HU比(51 ±23) HU],差異有統計學意義(P＜0.05).觀察組Couinaud各段灌註量參數值各不相同,且各段肝動脈灌註量、門靜脈灌註量、全肝總灌註量及肝動脈灌註指數參數差異均有統計學意義(均P＜0.05);其中肝髒SⅢ段與SⅦ段每灌註100 ml的肝動脈灌註量值分彆為(11±5) ml/min、(10±5)ml/min,二者差異有統計學意義(P＜0.05).肝髒各葉門靜脈灌註量與全肝總灌註量在觀察組A級、B級、C級患者均低于對照組,差異均有統計學意義[門靜脈灌註量:尾狀葉(58.3 ±31.2)、(68.7±21.0)、(58.9±30.7)ml/min比(92.7±44.7)ml/min,左外葉(57.6 ±21.0)、(68.3 ±20.8)、(58.5 ±23.8) ml/min比(87.0 ±34.4) ml/min,左內葉(63.5 ±23.2)、(73.2±22.1)、(62.1 ±31.8) ml/min比(84.2±27.3) ml/min,右前葉(69.5 ±28.5)、(70.7 ±28.4)、(70.5±27.5)比(91.8 ±24.1)ml/min,右後葉(56.5 ±16.8)、(68.1 ±25.8)、(57.9±15.8)比(91.6±23.6) ml/min;全肝總灌註量尾狀葉:(68.3±21.2)、(78.7±31.0)、(68.9±30.7)ml/min比(102.7±43.7) ml/min,左外葉(67.6±21.0)、(78.3±25.8)、(68.5±30.8)ml/min比(104.0±34.4)ml/min,左內葉(63.5±23.2)、(68.2±22.1)、(72.1±38.8) ml/min比(94.2±27.3) ml/min,有前葉(69.5 ±28.5)、(70.7±28.0)、(70.5±27.5) ml/min比(98.8 ±34.1)ml/min,右後葉(66.5±26.8)、(68.1 ±25.8)、(77.9±35.8)ml/min比(101.6±34.6) ml/min;均P＜0.05];肝動脈灌註量差異無統計學意義(p＞0.05).結論 基于Couinaud分段的血流狀態不儘相同,MSCT全肝灌註成像能反映Couinaud各段的血流狀態變化,有助于評價肝硬化各級的血流狀態.
목적 탐토기우Couinaud분단다층라선CT(MSCT)전간관주성상대만성을형간염간경화환자혈류상황적평고개치.방법 선취2013년1월지2014년1월재산동성빈주시중심의원진행치료적50례만성을형간염간경화환자위관찰조,령선취50명동기래본원진행체검적정상간장자위대조조.대소유대상행기우Couinaud분단MSCT전간관주성상,측량각단관주삼수,장간경화안간공능Child-pugh분급표준분위A급(23례)、B급(20례)、C급(7례),여정상조간장오협혈류관주삼수진행비교.결과 관찰조관주봉치시간교대조조장[주동맥:(15±4)s비(14±3)s,문정맥:(36±8)s비(29±5)s,비장:(27±6)s비(23±5)s]、강화봉치교대조조저[주동맥:(266±54) HU비(272±53) HU,문정맥:(81 ±31)HU비(91 ±34)HU,비장:(35 ±15)HU비(51 ±23) HU],차이유통계학의의(P＜0.05).관찰조Couinaud각단관주량삼수치각불상동,차각단간동맥관주량、문정맥관주량、전간총관주량급간동맥관주지수삼수차이균유통계학의의(균P＜0.05);기중간장SⅢ단여SⅦ단매관주100 ml적간동맥관주량치분별위(11±5) ml/min、(10±5)ml/min,이자차이유통계학의의(P＜0.05).간장각협문정맥관주량여전간총관주량재관찰조A급、B급、C급환자균저우대조조,차이균유통계학의의[문정맥관주량:미상협(58.3 ±31.2)、(68.7±21.0)、(58.9±30.7)ml/min비(92.7±44.7)ml/min,좌외협(57.6 ±21.0)、(68.3 ±20.8)、(58.5 ±23.8) ml/min비(87.0 ±34.4) ml/min,좌내협(63.5 ±23.2)、(73.2±22.1)、(62.1 ±31.8) ml/min비(84.2±27.3) ml/min,우전협(69.5 ±28.5)、(70.7 ±28.4)、(70.5±27.5)비(91.8 ±24.1)ml/min,우후협(56.5 ±16.8)、(68.1 ±25.8)、(57.9±15.8)비(91.6±23.6) ml/min;전간총관주량미상협:(68.3±21.2)、(78.7±31.0)、(68.9±30.7)ml/min비(102.7±43.7) ml/min,좌외협(67.6±21.0)、(78.3±25.8)、(68.5±30.8)ml/min비(104.0±34.4)ml/min,좌내협(63.5±23.2)、(68.2±22.1)、(72.1±38.8) ml/min비(94.2±27.3) ml/min,유전협(69.5 ±28.5)、(70.7±28.0)、(70.5±27.5) ml/min비(98.8 ±34.1)ml/min,우후협(66.5±26.8)、(68.1 ±25.8)、(77.9±35.8)ml/min비(101.6±34.6) ml/min;균P＜0.05];간동맥관주량차이무통계학의의(p＞0.05).결론 기우Couinaud분단적혈류상태불진상동,MSCT전간관주성상능반영Couinaud각단적혈류상태변화,유조우평개간경화각급적혈류상태.
Objective To explore the value of whole liver perfusion imaging by multi-slice spiral computed tomography (MSCT) based on Couinaud segments to evaluate the blood flow state in patients with chronic hepatitis B cirrhosis.Methods Totally 50 patients with chronic hepatitis B cirrhosis from January 2013 to January 2014 were selected as observation group, according to Child-pugh grading, the patients were divided into grade A (23 cases) , grade B (20 cases) and grade C (7 cases);in addition, 50 healthy volunteers with normal liver were set as control group.The MCST whole liver perfusion imaging based on Couinaud segments was performed, the perfusion parameters were measured and compared among groups.Results The peak time in observation group was significantly longer than that in control group [aorta: (15 ± 4) s vs (14 ± 3) s, portal vein: (36 ± 8) s vs (29 ± 5) s, spleen: (27 ± 6) s vs (23 ± 5) s];the peak enhancement in observation group was significantly lower than that in control group [aorta: (266 ±54) HU vs (272 ±53) HU, portal vein: (81 ±31) HU vs (91 ±34) HU, spleen: (35 ±15) HU vs (51 ±23) HU] (P＜0.05).In observation group, the perfusion parameter of each Couinaud(s) segment was not the same and the portal venous perfusion, total hepatic perfusion and hepatic perfusion index were significantly different (P ＜ 0.05);at S Ⅲ and SV segment, the hepatic arterial perfusion per 100 ml was significantly different [(11 ± 5) ml/min vs (10 ± 5) ml/min] (P ＜ 0.05).The hepatic portal vein perfusion and whole liver perfusion were significantly lower in cirrhosis patients with Chfld-Pugh grade of A, B, C than those in control group [portal vein perfusion : caudate lobe (58.3 ± 31.2), (68.7 ± 21.0), (58.9 ±30.7) ml/min vs (92.7 ±44.7) ml/min;left lateral (57.6 ±21.0), (68.3 ±20.8), (58.5 ±23.8) ml/min vs (87.0±34.4) ml/min;left lobe (63.5 ±23.2), (73.2 ±22.1), (62.1 ±31.8)ml/min vs (84.2 ±27.3) ml/min;right anterior lobe (69.5 ± 28.5), (70.7 ± 28.4), (70.5 ± 27.5) ml/min vs (91.8 ± 24.1) ml/min;right posterior leaf(56.5 ± 16.8), (68.1 ± 25.8), (57.9 ± t5.8) ml/min vs (91.6 ± 23.6) ml/min;whole liver perfusion: caudate lobe (68.3 ±21.2) , (78.7 ±31.0), (68.9 ± 30.7) ml/min vs (102.7 ±43.7) ml/min;left lateral(67.6 ±21.0), (78.3 ±25.8), (68.5 ±30.8)ml/min vs (104.0 ±34.4) ml/min;left lobe(63.5 ±23.2), (68.2 ± 22.1), (72.1 ± 38.8) ml/min vs (94.2 ± 27.3) ml/min;right anterior lobe (69.5 ± 28.5),(70.7 ±28.0), (70.5 ±27.5)ml/min vs (98.8 ±34.1) ml/min;right posterior leaf(66.5 ±26.8), (68.1 ±25.8), (77.9 ±35.8) ml/min vs (101.6±34.6) ml/min] (all P ＜0.05);there was no statistical significance in hepatic artery perfusion among groups (P ＞ 0.05).Conclusions Based on Couinaud segments, the liver blood flow of different segment was not the same;whole liver perfusion imaging by MSCT can reflect the change of blood flow of Couinaud segment, which is helpful to evaluate blood flow state of liver cirrhosis.
