^(31)P-MRS在评估肝硬化及其分级中的价值

Evaluation of Liver Cirrhosis and Its Child-Pugh Stage Using Vivo 31-phosphorus Magnetic Resonance Spectroscopy at 3.0 Tesla

目的探讨31P-磁共振波谱(MRS)无创评估肝硬化及其分级的价值。资料与方法分别对53例肝硬化患者及28名正常对照组进行单体素31P-MRS扫描,计算肝细胞内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、PME/ATP、Pi/ATP、PCr/ATP、PME/PDE、PME/Pi、PDE/Pi、PDE/ATP比值和低能磷酸盐(LEP)等代谢指标。探讨以上各参数在肝硬化及其Child-Pugh分级中的异同。结果在肝硬化组,PME、PME/ATP、PME/PDE及PME/Pi均大于正常对照组(P<0.05);而Pi则相反(P=0.023;t=2.340)。肝硬化Child-Pugh分级A、B、C级的PME分别为424.23±127.74、468.32±156.10、497.52±169.84,Pi分别为418.02±108.29、353.80±98.81、302.11±74.37,PME/Pi分别为1.03±0.45、1.41±0.59、1.82±0.62,均存在统计学意义(P值分别为0.047、0.038、0.042;F值分别为3.425、4.489、3.811),而其他代谢物在肝硬化及其分级中差异无统计学意义(P>0.05)。结论肝硬化时PME相关参数明显升高,PME、Pi和PME/Pi可对肝硬化的程度进行评估。

Objective To explore the value of vivo ^31-phosphorus magnetic resonance spectroscopy（ ^31P-MRS） in evaluating liver cirrhosis and the Child-Pugh stage. Materials and Methods ^31P-MRS scanning with a single voxel on hepatic parenchyma was carried out in 53 patients with liver cirrhosis and in 28 normal cases. Intracellular pH value （pHi）, and some metabolic parameters including phosphomonoester （ PME ）, phosphodiester（ PDE ）, inorganic phosphate （ Pi ）, phosphoereatine（PCr） ,γ-ATP, β-ATP,α-ATP, lower energetic phosphate（LEP） ,and the ratios of PME/ATP, Pi/ATP,PCr/ATP, PME/PDE, PME/Pi, PDE/Pi and PDE/ATP were calculated. The changes of those parameters above in liver cirrhosis and the Child-Pugh stage were analyzed. Results ^31p-MRS showed an increase in PME,PME/ATP,PME/PDE and PME/Pi in liver cirrhosis patients compared with controls （ P 〈 0.05 ） , whereas the Pi was reverse （ P = 0. 023 ; t = 2. 340 ）. Among Child-Pugh stage A,B and C, there were statistical differences in PME, which were 424.23 ± 127.74,468.32 ± 156. 10, 497.52 ± 169.84,in Pi ,418.02 ±108.29,353.80 ± 98.81,302.11 ± 74, 37 and in PME/Pi, 1.03 ± 0.45,1.41 ± 0.59 and 1.82 ± 0.62 （ The P values were 0. 047,0.038 and 0. 042, and the F values 3. 425,4. 489 and 3.811 respectively）. No statistical differences were found in others parameters （ P 〉 0.05 ）. Conclusion The PME of cirrhotic liver is increased compared with the normal liver. PME, Pi and PME/Pi may be useful to evaluate non-invasively the extent of cirrhosis.