实用器官移植电子杂志

实用器官移植电子杂志 ›› 2020, Vol. 8 ›› Issue (5): 353-360.DOI: 10.3969/j.issn.2095-5332.2020.05.006

• 论著 • 上一篇    下一篇

肝硬化对Gd-EOB-DTPA增强MRI后肝肾排泄途径的影响

何晴 1 ，谢双双 2 ，石茜 2 ，季倩 2
  

  1. 1. 天津医科大学一中心临床学院放射科，天津 300192 ； 2. 天津市第一中心医院放射科，天津 300192
  • 出版日期:2020-09-20 发布日期:2021-06-02

Gd-EOB-DTPA enhanced MRI imaging ：difference and relationship of hepatic and renal excretion pathways in patients with liver cirrhosis

He Qing 1 ，Xie Shuangshuang 2 ，Shi Qian 2 ，Ji Qian 2 .   

  1. 1. First Central Clinical Collage，Tianjin Medical University，Tianjin 300192，China； 2.Department of radiology，Tianjin First Central Hospital，Tianjin 300192，China.
  • Online:2020-09-20 Published:2021-06-02

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摘要：

目的 研究肝硬化患者在肝钆塞酸二钠（gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid，Gd-EOB-DTPA）增强后的排泄方式差异及联系，探讨肝肾增强程度之间以及与血液生化指标的关 系。方法 27 例肝硬化患者〔CP（Child-Pugh）A 级组 17 例，CP B/C 级组 10 例〕和 17 例肝肾功能正常 成人（对照组）接受平扫及 Gd-EOB-DTPA 增强 MRI 检查，测量并计算受试者肝胆期 5、10、15 min 和 20 min 的肝脏、门静脉与同层面竖脊肌信号强度比值和肾髓、皮质与同层面竖脊肌信号强度的比值，同时 收集所有入组者血液生化指标，比较不同时间点 3 组之间的各比值差异，分析各比值与生化指标的相关性。 结果 肝胆期各时间点 3 组之间的 SI 肝 /SI 竖脊肌 1 差异均有统计学意义（P ＜ 0.05），肝胆期 15 min 及 20 min 3 组之间的 SI 门静脉 /SI 竖脊肌 1 差异均有统计学意义（P ＜ 0.05），其余各时间点各组间差异均无统计学意义（P ＞ 0.05）。SI 肾髓质 /SI 竖脊肌 2 ：对照组与 CP B/C 组在肝胆期 15 min 和 20 min 差异有统计学意义（P ＜ 0.05），CP A 组与 CP B/C 组在 5、15、20 min 差异有统计学意义（P ＜ 0.05），而对照组与 CP A 组仅在 5 min 时差异 有统计学意义（P ＜ 0.05）。SI 肾皮质 /SI 竖脊肌 2 ：对照组与 CP B/C 组、CP A 组与 CP B/C 组在 10、15 和 20 min 差异有统计学意义（P ＜ 0.05），对照组与 CP A 组在 15 及 20 min 差异均有统计学意义（P ＜ 0.05）。 20 min 时 SI 肝 /SI 竖脊肌 1 与 Alb 呈高度正相关，与 AST 呈高度负相关，与 TBiL、Glb、γ-GT、PT 呈中度负相关； SI 肾髓质 /SI 竖脊肌 2、SI 肾皮质 /SI 竖脊肌 2 与 SI 肝 /SI 竖脊肌 1 呈中度负相关，与 SI 门静脉 /SI 竖脊肌 1 呈中度正相关，与 Cr、 eGFR 不相关。结论 肾功能正常的肝硬化患者 Gd-EOB-DTPA 的胆道排泄减少，肾脏排泄代偿增加，排泄 时间延长，且与肝硬化程度有关。Gd-EOB-DTPA 增强 MRI 评估肝硬化程度具有较好的临床相关性，肾脏 增强程度可以间接提示肝功能损害程度。

关键词: 肝硬化 , 肝钆塞酸二钠 , 磁共振成像 , 排泄方式

Abstract:

Objective To study the differences and relationship of hepatic and renal excretion patterns in patients with liver cirrhosis after gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid（Gd-EOB-DTPA） enhanced magnetic resonance imaging（MRI）. To explore the relationship between the level of liver and kidney enhancement and blood biochemical indicators. Methods Twenty-seven patients with cirrhosis CP（ChildPugh），including17 patients with grade A（CP A），10 patients with grade B or C（CP B/C）and 17 adults with normal liver and kidney function（control group）underwent plain scan and Gd EOB-DTPA enhanced MRI. At 5，10，15 and 20 minutes after bolus administration of Gd-EOB-DTPA，the signal intensity ratios of liver，portal vein and theerector muscle of spine at the same level ，and ratios of signal intensity of renal medulla and cortex to the erector muscle of spine at the same level were measured and calculated. The blood biochemical makers of all the participants were collected. The differences of ratios between the three groups at different time points were compared and the correlation between different indices were analyzed. Results There was significant difference in Sliver/SImuscle1 between the groups at each time point of hepatocyte-specific phase（P ＜ 0.05）. There was significant difference in SIportal vein/SImuscle1 between the groups at 15 and 20 minutes of hepatocyte-specific phase（P ＜ 0.05）and no significant differences between the groups at other time points（P ＞ 0.05）. Regarding the SImedulla/SImuscle2 ：significant differences were found between the control group and CP B/C group at 15 and 20 minutes（P ＜ 0.05）. There was significant difference between the CP A group and CP B/C group at 5，15 and 20 minutes. There was significant difference between control group and CP A group at 5 minutes. Concerning the SIcortex/SImuscle2 ：there were significant differences between the control group and CP B/C group and between the CP A group and CP B/C group at 10，15 and 20 minutes. There were significant differences between the control group and CP A group at 15 and 20 minutes. At 20 minutes，Sliver/SImuscle1 was highly positively correlated with Alb，and highly negatively correlated with AST （P ＜ 0.05）.Sliver /SImuscle1 was moderately negatively correlated with TBiL， Glb， γ-GT and PT （P ＜ 0.05）； SImedulla/SImuscle2 and SIcortex/SImuscle2 were moderately negatively correlated with Sliver /SImuscle1 and moderately positively correlated with Sportal vein/SImuscle1 （P ＜ 0.05）. SImedulla/SImuscle2 and SIcortex/SImuscle2 were not correlated with Cr and eGFR（P ＞ 0.05）. Conclusion Biliary tract excretion of Gd-EOB-DTPA is decreased in patients with liver cirrhosis with normal renal function，the renal excretion compensation is increased and the excretion time is prolonged in these patients. The degree of the renal excretion and time is related to the level of liver cirrhosis. The evaluation of liver cirrhosis by Gd-EOB-DTPA enhanced MRI has a good clinical relevance. The degree of renal enhancement can indirectly indicate the degree of liver function damage.

Key words: Liver cirrhosis , Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid , Magnetic resonance imaging, Excretion pattern

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