DSA灌注成像在急性缺血-再灌注损伤兔模型中的应用

Application of DSA perfusion imaging in rabbit model with acute ischemia-reperfusion injury

目的探讨DSA灌注成像技术评估骨骼肌缺血-再灌注损伤(IRI)的应用价值。方法将30只新西兰大白兔随机分为IRI0h组、6h组、12h组、24h组和对照组,每组各6只。IRI各组分别在右下肢缺血3h恢复血流灌注后0h、6h、12h、24h接受双下肢动脉3DDSA造影,对照组不予特殊处理即行双下肢动脉3D造影,同时检测血清肌酸激酶(CK)、乳酸脱氢酶(LDH)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平变化。用DSA灌注成像后处理软件Syngo DynaPBV分析造影图像,计算出双下肢灌注参数之血流容积(BV)及其两者比值之相对血流容积(rBV),将各时点测得的rBV与实验室指标作相关性分析。结果与对照组相比,DSA灌注参数rBV在IRI6h组、12h组、24h组间差异有统计学意义(P<0.05);IRI各组间比较,rBV随再灌注时间延长逐渐降低(F=5.816,P<0.05)。Pearson相关性分析显示,IRI组各时点rBV值与实验室检查指标CK(r=-0.91,P<0.05)、LDH(r=-0.90,P<0.05)、MDA(r=-0.85,P<0.05)呈负相关,与SOD(r=0.74,P<0.05)呈正相关。结论术中应用DSA灌注成像技术评估肢体IRI安全可行,其灌注参数与实验室指标间有较好相关性,可实时评估术中骨骼肌IRI程度。

Objective To discuss the application value of DSA perfusion imaging technique in the evaluation of skeletal muscle ischemia- reperfusion injury(IRI).Methods Thirty New Zealand white rabbits were randomly and equally divided into five groups with 6 rabbits in each group:including 0- hour,6- hour, 12- hour and 24- hour IRI groups(study group) and control group.The right lower limb ischemia lasting for 3 hours was produced by artery ligation,and at 0- hour,6- hour,12- hour and 24- hour after restoration of blood perfusion 3D-DSA angiography of bilateral lower extremity arteries was separately performed for the experimental rabbits of the corresponding IRI group.For the rabbits of the control group,3D- DSA angiography of bilateral lower extremity arteries was directly carried out with no special treatment.The serum levels of creatine kinase (CK),lactate dehydrogenase (LDH),malondialdehyde (MDA)and superoxide dismutase (SOD)were tested. Using DSA perfusion imaging post - processing software Syngo DynaPBV,the angiographic images were analyzed,the blood flow volume(BV) and relative blood flow volume (rBV)of both lower extremity perfusion parameters were calculated,and the correlation analysis between rBV measured at different time points and the above mentioned laboratory indexes was conducted.Results Compared with the control group,in the study group statistically significant difference in rBV value of DSA perfusion parameter existed between each other among 6- hour,12- hour and 24- hour IRI groups(P<0.05).The comparison among the 4 IRI groups showed that along with the prolongation of reperfusion time,rBV value decreased gradually (F =5.816,P<0.05). Pearson correlation analysis indicated that in each IRI group the rBV value of each time point bore a negative relationship with CK(r=-0.91,P<0.05),LDH(r=-0.90,P<0.05) and MDA(r=-0.85,P<0.05),while had a parallel relationship with SOD(r=0.74,P<0.05).Conclusion For the evaluation of skeletal muscle IRI, intraoperative use of DSA perfusion imaging technique is safe and feasible.The perfusion parameters of DSA are well correlated with laboratory indexes,which are very helpful in making real- time evaluation of skeletal muscle IRI during operation.