^(99)Tc^m-MIBI经直肠-门脉闪烁显像对肝硬化伴门脉高压患者的鉴别诊断和疗效评估

Clinical evaluation of ^(99)Tc^m-MIBI per-rectal portal scintigraphy in differential diagnosis and efficacy of drug therapy for patients with portal hypertension of hepatocirrhosis

目的 评价 99Tcm- MIBI经直肠 -门脉闪烁显像对肝硬化伴门脉分流患者的鉴别诊断和药物疗效观察的临床应用价值 .方法 经直肠给于 11例非肝病患者、15例慢性肝病患者和 31例肝硬化患者 740 MBq(2 0 m Ci) 99Tcm- MIBI,即用SPECT行 1帧 / 5 min× 18动态采集及 90 min后静态扫描 ,计算其心 /肝 (H/ L)比值 .并且对 2 9例肝硬化患者进行了尼群地平用药前后的 H/ L 观察 .结果 非肝病组 H/ L 为 0 .2 4± 0 .0 4,慢性肝病组 CPH (0 .48± 0 .0 7)和 CAH (0 .5 7±0 .0 3)三者的 H/ L呈递增趋势 ,肝硬化组 (1.0 1± 0 .36 ) H/ L显著升高 ,其中 Child- Pugh A,B和 C级 H/ L 分别为 0 .6 3±0 .0 9,0 .92± 0 .14及 1.5 5± 0 .2 3呈趋势相关 .以 H/ L≥0 .6 4为门脉高压阳性 ,则诊断肝硬化门脉高压的灵敏度为93.0 % ,特异性 92 .0 %及符合率为 93.0 % .用尼群地平治疗肝硬化门脉高压前后 H/ L的观察 ,治疗前 1.0 4± 0 .35 ,而治疗后为 0 .82± 0 .2 0呈较明显降低 (P<0 .0 1) ,提示其有较好的减低门脉压效果 .结论 99Tcm - MIBI经直肠 -门脉显像可较好的鉴别诊断肝硬化门脉分流及评估药物疗效 ,是一个可靠。

AIM To evaluate the clinical value of 99 Tc m-MIBI per-rectal portal scintigraphy in differentiating liver cirrhotic portal hypertension and the effects of drug therapy. METHODS Eleven control cases, 15 chronic liver diseases and 31 liver cirrhosis patients were studied. All patients were examined by per-rectal scintigraphy 90 min after 740 MBq 99 Tc m-MIBI being administered and the uptake ratio of heart over liver (H/L) interested region (ROI) was measured. RESULTS The heart to liver (H/L) uptake ratio of 99 Tc m-MIBI in control group was 0.24±0.04, gradually elevated to 0.48±0.07 and 0.57±0.03 in chronic procrastinating hepatitis (CPH) and chronic active hepatitis (CAH) groups respectively, and markedly elevated to 1.01±0.36 in liver cirrhosis group. H/L in cirrhosis group and chronic liver disease group compared with control group was different significantly ( P <0.01). These patients with liver cirrhosis of Child-Pugh classification A, B and C were 0.63±0.09, 0.92±0.14 and 1.55± 0.23 respectively. The results showed that there was a trend correlation between H/L and Child-Pugh classification. If 0.64 was taken as a cut off value of H/L, the sensitivity, specificity and crude agreement for diagnosis of portal hypertension were 93%, 92% and 93% respectively. The Nitrendipine was used to treat liver cirrhotic portal hypertension. The results also showed that H/L of the patient post-therapy compared with that of pre-therapy was obviously decreased, indicating that Nitrendipine had good effects for lowering portal hypertension. CONCLUSION 99 Tc m-MIBI per-rectal portal scintigraphy is a reliable, safe and noninvasive method for the diagnosis of portal hypertension in patients with cirrhosis and the observation of curative effects.