弹性成像联合超声造影技术无创性监测肝脏缺血再灌注损伤的机制及价值研究

Ischemia-reperfusion injury (IRI) is the most frequent pathophysiologic procedure during liver resection and liver transplantation. Surveillance of liver IRI procedure in clinic is insufficient and mainly for monitoring liver function. CT and MR is hard to be used in postoperative intensive care therapeutic patients due to irremovability and Ultrasound is the preferred imaging method in those patients due to the advantages of flexible, convenient and easy carrying out at the bedside. Study of pathophysiology demonstrate: during the procedure of liver IRI, stiffness of liver parenchyma progress due to hepatocyte nocrosis and fibrosis, and microcirculation obstruction lead to blood flow decrease in liver. Therefore, this study intends to establish the model of New Zealand rabbits with liver resection following blocking blood supply and the model of cirrhosis New Zealand rabbit with liver resection following blocking blood supply, employ Elastography and contrasted enhanced Utrasound (CEUS) to monitor liver IRI from liver stiffness and blood flow and compare with pathology, laboratory examination and MR, clarify the mechanism of Elastography and CEUS in monitoring liver IRI, investigate the feasibility of combining Elastography with CEUS in monitoring liver IRI. This study also intends to carry out clinical trial and further identify the clinical value of combining Elastography with CEUS in monitoring liver IRI.

缺血再灌注损伤（ischemia-reperfusion injury，IRI）是肝切除及肝移植术中常发生的病理生理过程。目前临床对其监测手段单一，主要为监测肝功能。CT、MR检查因其仪器无法移动而难以应用于术后重症监护患者，超声检查灵活、方便、可在床边进行的优点使其成为重症监护患者的首选影像学检查方法。病理生理学研究证实：肝脏IRI进程中，同时伴随着肝实质坏死、纤维化形成导致的组织硬度增加及肝内微循环障碍导致的血流灌注改变。因此本研究拟建立新西兰兔阻断入肝血流的肝切模型及肝硬化新西兰兔阻断入肝血流的肝切模型，利用弹性成像及超声造影技术从肝脏质地及血流灌注两方面监测肝脏IRI进程，并与病理、实验室检查、MR检查对比分析，阐明弹性成像及超声造影成像技术评估肝切除过程肝脏IRI的机理，探讨弹性成像联合超声造影成像技术无创性评估肝脏IRI的可行性。并进行临床实验，进一步验证其临床应用价值。

肝脏缺血再灌注损伤 (hepatic ischemia reperfusion injury, HIRI) 是导致肝脏手术术后肝功能衰竭的主要原因之一，直接影响患者的预后。临床上通常应用监测患者肝功能水平来评估HIRI的肝功能损伤程度，但是它们并不能确切提供HIRI后肝组织损伤的形态学特征及微循环障碍等情况。如何无创性监测并预防HIRI有助于提高手术安全系数。本研究通过建立正常新西兰兔阻断入肝血流的肝切模型及肝硬化新西兰兔阻断入肝血流的肝切模型，利用弹性成像及超声造影技术从肝脏弹性及血流灌注两方面监测HIRI进程，并与病理、实验室检查、MR检查对比分析，阐明弹性成像及超声造影成像技术评估肝切除过程肝脏IRI的机理。在正常兔及肝硬化兔缺血再灌注后，随着时间的延长，血清AST、ALT水平持续升高，ARFI测值Vs明显较术前高，且随着缺血再灌注时间的延长而逐渐增大，超声造影TIC曲线参数RT、TTP也呈现出时间延长的变化，差异具有统计学差异，故弹性成像和超声造影能够监测肝脏缺血再灌注的变化。初步得出弹性成像联合超声造影成像技术能够无创性评估HIRI。