肝硬化患者钆塞酸二钠MR增强后排泄方式及对肾功能的影响

A study on the excretion of Gd-EOB-DTPA in patients with liver cirrhosis and its impact on renal function

目的研究肝硬化患者钆塞酸二钠MR增强后的排泄方式及对肾功能的影响。方法 48例肝硬化患者(CP?A级组29例,B/C级组19例)和16例正常成人(对照组)行钆塞酸二钠动态增强和肝胆期成像,测量三组受试者肝胆期5、10、15、20、25?min肾脏和骶脊肌信号强度并计算两者比值,比较三组之间比值差异以及肝硬化A级和B/C级患者增强前后血清肌酐和尿素氮差异。结果三组的肾脏/骶脊肌信号强度比值差异有统计学意义(F?=?6.384,P?=?0.003),其中CP?B/C级组与CP?A级组、CP?B/C级组与对照组的肾脏/骶脊肌信号比值差异有统计学意义(P?=?0.002,P?=?0.005),而CP?A级组与对照组之间差异无统计学意义(P?=?0.979)。CP?A级组、B/C级组各自增强前后以及这两组增强后血清尿素氮和肌酐水平差异均无统计学意义(P>?0.05)。结论肝硬化患者钆塞酸二钠肾脏排泄增加,时间延长,且与CP分级相关,但不会引起肾功能明显损害。

Objective To evaluate the excretion of Gd-EOB-DTPA in patients with liver cirrhosis and its impact on the renal function. Methods 48 patients with liver cirrhosis （including 29 subjects in Child-Pugh A group, and 19 in B/C group）, and 16 healthy volunteers （control group） were recruited for the study. Gd-EOB- DTPA-enhanced MR dynamic and hepatobiliary phase imaging were performed for all three groups. The signal intensity of renal parenchyma and erector spinae were measured at 5, 10, 15, 20 and 25 minutes after injection during hepatobiliary phase, the signal intensity ratio of renal-to-erector spinae were also compared. In cirrhostic patients, the serum urea nitrogen and creatinine level were recorded before and after administration of contrast agents, their differences between the Child-Pugh A group and B/C group were compared. Results There was a significant difference in the signal intensity ratio of renal-to-erector spinae had significantly differences among three group （F = 6.384, P = 0.003 ）, between Child-Pugh B/C group and Child-Pugh A group （P = 0.002 ）, and between Child-Pugh B/C group and control group （P = 0.005）, no difference was found between Child-Pugh A group and control group （P = 0.979）. Each item of serum urea nitrogen and crearinineleve between pre-and post-contrast had no difference in Child-Pugh A group and Child-Pugh B/C group （P 〉 0.01 ）, so dxa tne serum urea nitrogen and crearinineleve after administration of contrast agents between the two groups. Conclusion The renal excretion of Gd-EOB-DTPA was increased and the excretory period was prolonged in cirrhotic patients that was correlated with level of liver function and was not of impaired to renal function.