超声造影定量分析评价肝移植术后移植肝微循环灌注的应用价值

Quantitative evaluation of the liver microcirculation changes after liver transplantation by contrast-enhanced utrasound

目的利用超声造影定量分析评价肝移植术后移植肝微循环灌注情况并与丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）对比分析，探讨超声造影定量分析无创性评价移植肝缺血再灌注损伤动态变化的可行性。方法对成功实施肝移植手术的14例患者分别于术后1d、3d、7d进行超声造影及肝功能检查，并利用SonoLiverCAP软件定量分析超声造影图像获取TIC曲线，术后7d行增强CT检查。结果肝移植术后3次超声造影肝实质均呈均匀增强，术后1d与术后3d、7d肝实质造影剂灌注的峰值强度、上升时间、达峰时间比较差异均有统计学意义（P〈0．05），Pearson相关分析提示肝实质灌注峰值强度与血清AST及ALT之间存在良好的相关性（r值分别为-0．62、-0．47，P〈0．05），上升时间及达峰时间与血清ALT之间呈低度相关性（r值分别为0．40、0．38，P〈0.05）。结论超声造影定量分析可以动态、准确地评估肝移植术后肝实质微循环的变化情况，可作为移植肝围手术期动态监测灌注情况的首选影像学方法。

Objective To investigate the liver microcirculation changes after liver transplantation by quantitative analysis of contrast-enhanced ultrasonography （CEUS）, and evaluate the feasibility that noninvasive assessment of the change of liver function led by ischemia reperfusion injury after liver transplantation by quantitative analysis of CEUS. Methods Fourteen patients after liver transplantation were involved. CEUS and liver function test were performed at 1 d, 3 d, 7 d after liver transplantation. SonoLiver CAP was used and TIC curve were obtained. Contrast enhanced CT were performed at 7 d after liver transplantation. Results The livers aftet transplantation showed homogeneous enhancement. The quantitative parameters at 1 d after liver transplantation included maximum intensity （IMAX）, rise time （RT）, time to peak（TTP） were significant different with those at 3 d, 7 d after liver transplantation. Pearson correlation analysis demonstrated that there were significantly correlated between maximum intensity （IMAX） and aspartate aminotransferase （AST） or alanine aminotransferase （ALT） （ r = - 0.62, - 0.47, respectively, P 〈0.05）. The correlation was also significant between rise time（RT）, time to peak（TTP） and ALT（ r = 0.40, 0.38, respectively, P 〈0. 05）. Conclusions Quantitative analysis of CEUS may be reliable for noninvasive assessment of the liver microcirculation, and it may be the first choice of imaging method for dynamic monitoring of the liver function after liver transplantation.