常规超声及声辐射力脉冲成像检测化疗药物肝损害的实验研究

Experimental study on conventional ultrasound and acoustic radiation force pulse imaging detecting liver damage induced by chemotherapeutic drugs

目的探讨应用化疗药后药物对兔肝造成的病理损害及其常规超声表现和声辐射力脉冲成像(acoustic radiation force impulse imaging,ARFI)的测定值。方法雌性新西兰大耳白兔30只,随机分对照组(A组)、环磷酰胺+表柔比星组(B组)及环磷酰胺+表柔比星+脂肪乳组(C组),每组10只。用药前测定兔肝功能及血脂,对兔肝行常规超声及声辐射力脉冲成像检查,测定剪切波速度,应用6个周期化疗药后再次行上述检查,比较用药前后的肝功能、血脂、常规超声表现及剪切波速度值,最后行兔肝病理检查。结果 A组用药前后AST和ALT差异均无统计学意义(P>0.05),B组和C组用药后AST和ALT均较用药前明显升高(P<0.05),用药后B组和C组AST和ALT值均高于A组,C组又高于B组(P<0.05)。A组用药前后TC差异无统计学意义(P>0.05),B组和C组用药后TC均较用药前升高(P<0.05),用药后B组和C组TC值均高于A组,C组又高于B组(P<0.05);A组和B组用药前后TG差异均无统计学意义(P>0.05),C组用药后TG较用药前明显升高(P<0.05),且C组用药后TG明显高于A组和B组(P<0.05);A组应用安慰剂后超声未见异常;B组、C组应用化疗药后肝脏常规超声显示肝包膜增厚,体积轻度增大,外形饱满,不同程度实质回声增强、不均匀,胆管壁及门脉壁回声增强,肝内外胆管及门脉未见扩张,C组更为明显。A组用药前后剪切波速度差异无统计学意义(P>0.05),B组和C组用药后剪切波速度均较用药前有增加(P<0.05),用药后B组和C组剪切波速度均高于A组(P<0.05)。结论应用中短期化疗药疗程不能引起兔肝明显的脂肪肝病理损害,声辐射力脉冲成像可对化疗药物性肝损害进行定量评价。

Objective To investigate ultrasonographic characteristics,acoustic radiation force impulse imaging（ARFI）values and pathological findings of rabbit liver damage after using chemotherapeutic agents.Methods Thirty female New Zealand rabbits were randomly divided into 3groups,group A（control group）,group B（cyclophosphamide＋epirubicin group）,group C（cyclophosphamide＋epirubicin＋fat emulsion group）.The liver function and blood lipid were measured before and after treatment.The rabbit liver was examined by conventional ultrasound and acoustic radiation force imaging.After 6cycles of chemotherapy drugs,the liver function,blood lipid,conventional ultrasound and shear wave velocity were compared before and after treatment and livers were taken out for pathological observation.Results There was no significant difference in AST and ALT before and after treatment in group A（P〈0.05）.AST and ALT in group B and group C were markedly elevated after drug use（P〈0.05）,and were higher than group A.AST and ALT in group C were higher than group B（P〈0.05）.There was no significant difference in TC before and after treatment in group A（P〈0.05）,B in group C and group TC were higher than those before treatment（P〈0.05）,the TC values of B group and C group after treatment were higher than those of A group,C group was higher than B group.There was no significant difference in TG between the A group and the B group before and after treatment（P〈0.05）,the TG in the C group was significantly higher than that before treatment（P〈0.05）,and the TG in the C group was significantly higher than that in the A group and the B group（P〈0.05）. There was no abnormality in A group after placebo. After using chemotherapy in B group,C group,liver routine ultrasound examination revealed hepatic capsular thickening,volume slightly enlarged,plump shape,different degrees of echogenic,uneven,bile duct wall and portal vein wall echogenic extrahepatic bile duct and portal vein were dilated,C group was more obvious.There was no significant difference in shear wave velocity before and after treatment in A group（P〈0.05）.The shear wave velocity of B group and C group was higher than that before treatment（P〈0.05）,and the shear wave velocity of B group and C group after treatment was higher than that of A group（P〈0.05）.Conclusion A shortmiddle term administration of chemotherapeutic agents is not able to cause prominent fatty liver.ARFI can be utilized as a useful method for the quantitative evaluation of liver lesion caused by chemotherapeutic agents.