^(31)P-MR波谱对肝硬化时骨骼肌能量代谢的评估

Musculoskeletal metabolism in patients with liver cirrhosis by 31-phosphorus magnetic resonance spectroscopy at 3.0 Tesla in vivo

目的探讨31P-MRS技术评估肝硬化对骨骼肌代谢的影响。方法分别对35例肝硬化患者及30例正常对照组的大腿后方骨骼肌进行单体素31P-MRS扫描,计算骨骼肌细胞内pH值(pHi)、磷酸单酯(PME)、磷酸双酯(PDE)、无机磷(Pi)、磷酸肌酸(PCr)、γ-ATP、β-ATP、α-ATP、Pi/ATP、PCr/ATP、PCr/PME、PCr/PDE、PCr/Pi、PME/ATP、PME/PDE、PME/Pi、PDE/ATP、PDE/Pi等指标。分析肝硬化及其分级对骨骼肌31P-MRS指标的影响。结果肝硬化组骨骼肌的PME、PCr、β-ATP、PME/PDE及Pcr/PDE均大于正常对照组,而PDE/ATP则相反(P<0.05)。在Child-Pugh分级A、B、C级患者骨骼肌的pHi分别为7.18±0.10、7.20±0.10、7.41±0.08,具有统计学差异(P=0.041,F=4.629);PME/PDE分别为0.57±0.26、0.68±0.24、1.16±0.24,也存在明显差异(P=0.047,F=4.254),而其余代谢物指标未见统计学差异(P>0.05)。结论31P-MRS可以对肝硬化患者骨骼肌的异常代谢进行无创评估,骨骼肌pHi及PME/PDE随肝硬化Child-Pugh分级的增加而上升。

Objective To explore the value of in vivo 31-phosphorus magnetic resonance spectroscopy(31P-MRS) in detection of musculoskeletal metabolism for patients with liver cirrhosis.Methods 31P-MRS scanning with a single voxel on thigh skeletal muscle was carried out in 31 patients with liver cirrhosis and in 30 normal cases.Intracellular pH value(pHi) and some metabolic parameters including phosphomonoester(PME),phosphodiester(PDE),inorganic phosphate(Pi),phosphocreatine(PCr),γ-ATP,β-ATP,α-ATP,and the ratios of Pi...