超声造影检查无创评估放射性肝损伤患者可行性研究

doi:10.3969/j.issn.1672-5069.2020.05.018

摘要/Abstract

摘要： 目的比较腹部恶性肿瘤患者在三维适形放疗前后超声造影(CEUS)检查肝脏各定量参数,以探讨放射性肝损伤(RILI)患者这些定量参数的变化。方法 2016年6月～2020年1月我院接受放射治疗的腹部恶性肿瘤患者42例均接受放射治疗。采用CEUS检查,记录肝脏定量参数,如达峰时间(TTP)、曲线上升斜率(GRAD)和曲线下面积(AUC)。结果在三维适形放疗前、放疗2 w、放疗3 w和放疗4 w时,42例肿瘤患者肝脏TTP分别为(14.2±2.4)s、(18.5±3.0)s、(23.2±3.2)s和(30.1±4.0)s,差异具有统计学意义(P<0.05); GRAD分别为(2.1±0.2)、(1.6±0.1)、(1.0±0.1)和(0.7±0.1),差异具有统计学意义(P<0.05); AUC分别为(3220.8±120.4)、(2910.9±102.5)、(2785.5±101.2)和(3248.6±89.5),变化缺乏规律性;在放射治疗3 w和4 w时,血清ALT水平分别为(45.5±9.8)U/L和(60.8±10.5)U/L,AST水平分别为(44.8±10.2)U/L和(61.2±12.5)U/L,GGT水平分别为(74.3±7.5)U/L和(86.3±8.0)U/L,AKP水平分别为(96.8±36.0)U/L和(105.8±40.2)U/L,均显著高于放疗前(P<0.05),而达到RILI诊断标准。结论 CEUS检测肝脏TTP、GRAD和AUC等指标可作为早期诊断RILI的重要参考定量指标,客观地反映急性RILI患者肝内微循环的变化,有望成为诊断急性RILI的新指标。

关键词: 放射性肝损伤, 超声造影, 诊断 , ,

Abstract: Objective The purpose of this study was to investigate the feasibility of non-invasive evaluation by contrast-enhanced ultrasound (CEUS) in patients with radiation-induced liver injury (RILI). Methods A total of 42 patients with abdominal malignant tumors received radiotherapy in our hospital between June 2016 and January 2020. Color Doppler CEUS was conducted for measurement of the time to peak (TTP), the gradient (GRAD) and the area under the curve (AUC) in the livers. Results The TTP in the 42 patients at baseline, two, three and four weeks after radiotherapy were (14.2±2.4)s, (18.5±3.0)s, (23.2±3.2)s and (30.1±4.0)s, respectively, with significant differences between them (P<0.05); the GRAD were (2.1±0.2), (1.6±0.1), (1.0±0.1) and (0.7±0.1), significantly different (P<0.05), while the AUC were (3220.8±120.4), (2910.9±102.5), (2785.5±101.2) and (3248.6±89.5), lacking regularity; at week three and four, serum ALT levels were (45.5±9.8)U/L and (60.8±10.5)U/L, serum AST levels were (44.8±10.2)U/L and (61.2±12.5)U/L, serum GGT levels were (74.3±7.5)U/L and (86.3±8.0)U/L, and serum AKP levels were (96.8±36.0)U/L and (105.8±40.2)U/L, respectively, all significantly higher than at baseline or at week two after radiotherapy(P<0.05), meeting the diagnosis of RILI. Conclusion The measurementof TTP, GRAD and AUC by CEUS scan could be used as an important quantitative index for early diagnosis of RILI in patients with malignant tumors undergoing radiotherapy, which might accurately and objectively evaluate the changes of intrahepatic microcirculation in acute RILI.

Key words: Radiation-induced liver injury, Contrast-enhanced ultrasonography, Diagnosis

杨华, 曾畅, 罗芳, 张贵琼, 胡小丽. 超声造影检查无创评估放射性肝损伤患者可行性研究[J]. 实用肝脏病杂志, 2020, 23(5): 674-677.

Yang Hua, Zeng Chang, Luo Fang,et al.. Feasibility of non-invasive evaluation by contrast-enhanced ultrasound in patients with radiation-induced liver injury[J]. Journal of Practical Hepatology, 2020, 23(5): 674-677.

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