^(31)P-MRS无创评估梗阻性黄疸肝功能损害的价值

Evaluation of liver function status in patients with obstructive jaundice using in vivo 31-phosphorus magnetic resonance spectroscopy

目的:探讨31P-MRS技术评价梗阻性黄疸肝功能损害的价值。方法:对36例梗阻性黄疸患者(黄疸组)进行单体素31P-MRS扫描,计算肝细胞内pH值(pH)i、磷酸单脂(PME)、磷酸双脂(PDE)、无机磷(P)i、γ-ATP、β-ATP、α-ATP、PME/ATP、Pi/ATP、PME/PDE、PME/Pi、PDE/Pi、PDE/ATP和低能磷酸盐(LEP)等。检测临床肝功能血清学指标。以40例正常人为对照组,分析黄疸对31P-MRS检测参数的影响及其与肝功能血清检测指标之间的关系。结果:黄疸组肝脏PME、PDE、PME/ATP、PME/Pi、PDE/ATP及LEP均明显大于对照组,两组差异有统计学意义(P<0.05)。PME/Pi与ALP正相关(r=0.592,P=0.043)。PDE与DBIL(r=0.588,P=0.034)正相关,PDE/Pi分别与DBIL(r=0.647,P=0.017)、IBIL(r=0.583,P=0.037)及ALT(r=0.568,P=0.027)正相关;PME/PDE与ALB负相关(r=-0.739,P=0.003)。而Pi/ATP与A/G负相关(r=-0.569,P=0.034)。其余参数与各肝功检测值之间未见相关性(P>0.05)。结论:31P-MRS可以对梗阻性黄疸导致的肝功能损害进行无创性评估,PME和PDE代谢物可能是反映肝功能损害较为敏感的指标。

Objective： To evaluate the liver function status in patients with obstructive jaundice using in vivo 31-phosphorus magnetic resonance spectroscopy （^31p-MRS）. Methods：^31P-MRS scan with a single voxel on hepatic parenchyma was carried out in 31 patients with obstructive jaun dice and in 40 healthy controls. Intracellular pH value （pHi）, and some metabolic parameters including phosphomonoester （PME）, phosphodiester （PDE）, inorganic phosphate （Pi）, γ-ATP, β-ATP, α-ATP, lower energetic phosphate （LEP）, and the ratios of PME/ATP, Pi/ATP, PME/PDE, PME/Pi, PDE/Pi and PDE/ATP were calculated. Serum markers of liver function including AST, ALT, TBIL, DBIL, IBIL, TP, ALB, GLQ, A/G, ALP and GGT were also recorded. The relationship between themwas analyzed. Results： ^31P-MRS showed an increase in PME, PDE, PME/ATP, PME/Pi, PDE/ATP and LEP in jaundice patients compared with controls （P〈0.05）. The positive correlations were identified between PME/Pi and ALP （r=0.592, P=0.043）, PDE and DBIL （r=0.588, P=0.034）, and among PDE/Pi to DBIL （r=0.647, P=0.017）, IBIL （r=0.583, P=0.037）and ALT（r=0.568, P=0.027）, whereas the negative correlations were foundbetween PME/PDE and ALB （r=-0.739, P=0.003）, Pi/ATP and A/G （r=-0.569, P=0.034） （P〈0.05）. Conclusion： ^31P-MRS may be used to evaluate the liver damage caused by obstructive jaundice, and PME and PDE metabolites are the sensitive indexes for the evaluation.