肝脏灌注变化对部分脾动脉栓塞术后肝功能损伤影响分析

Analysis of the Effect of Liver Perfusion Changes on Liver Function Injury after Partial Splenic Artery Embolization

目的探讨部分脾动脉栓塞术(PSE)后肝脏CT灌注成像(CTP)及肝功能变化的影响,并分析肝脏CTP变化对肝功能损伤的影响。方法搜集2019年6月至2021年3月诊断为肝硬化脾功能亢进并行PSE治疗共28例患者的临床资料,计算其终末期肝病模型(MELD)评分,勾画测量栓塞前后脾脏体积,利用肝脏CTP测量肝动脉灌注量(HAP)、门静脉灌注量(PVP)、总肝灌注量(TLP),将其设为自变量,将MELD评分设为因变量进行多元线性回归分析。结果术前脾脏平均体积V_(前)为(1196.38±362.31)cm^(3),栓塞后脾脏平均体积V_(后)为(603.28±316.26)cm^(3),平均栓塞体积V_(前)-V_(后)为(593.10±112.68)cm^(3),平均栓塞率V_(前)-V_(后)/V_(前)为(50.9±10.8)%。PSE术前、术后1周及术后2个月灌注量:HAP 16.51、21.93、22.30 ml·min^(-1)·100 ml^(-1)(P<0.05),PVP 93.86、36.89、63.86 ml·min^(-1)·100 ml^(-1)(P<0.05),TLP 110.72、58.51、89.17 ml·min^(-1)·100 ml^(-1)(P<0.05);PSE术前、术后1周及术后2个月MELD评分:9.15、11.18、7.32;根据多元线性回归方程分析(F=9.687、P<0.001),术后1周PVP与MELD评分有线性关系,其回归标准化系数(B)为-0.952,表明二者相互之间呈负相关关系。结论PVP的减小,是PSE术后一过性肝功能损伤的重要影响因素。

Objective To explore the effects of liver CT perfusion and liver function changes after partial splenic artery embolization(PSE),and analyze the effects of liver CT perfusion changes on liver function damage.Methods Collected the clinical data of 28 patients diagnosed with hypersplenism of liver cirrhosis and PSE treatment from June 2019 to March 2021,calculated their end-stage liver disease model(MELD) score,outline and measure the spleen volume before and after embolization,and used CT whole liver Perfusion imaging to measure hepatic artery perfusion(HAP),portal vein perfusion(PVP),and total liver perfusion(TLP),which were set as independent variables,and MELD score was set as dependent variable for multiple linear regression analysis.Results The average volume of the spleen before operation was(1196.38±362.31)cm~3,the average volume of the spleen after embolization was(603.28±316.26)cm~3,the average embolization volume was(593.10±112.68)cm~3,and the average embolization rate was(50.9±10.8)%.Perfusion volume before PSE,1 week and 2 months after operation:HAP 16.51/21.93/22.30 ml·min^(-1)·100 ml^(-1)(P<0.05),PVP 93.86/36.89/63.86 ml·min^(-1)·100 ml^(-1)(P<0.05),TLP 110.72/58.51/89.17 ml·min^(-1)·100 ml^(-1)(P<0.05);PSE before operation,1 week and 2 month after operation Monthly MELD score:9.15/11.18/7.32;According to the analysis of multiple linear regression equation(F =9.687、P<0.001),PVP and MELD score have a linear relationship,and the regression standardized coefficient(B) is-0.952,indicating that the two are mutually There is a negative correlation between them.Conclusion The decrease of portal vein perfusion is an important factor affecting transient liver function injury after PSE.