螺旋CT肝血流灌注参数对乙型肝炎肝硬化门静脉高压患者TIPS术后肝血流灌注的评估

摘要/Abstract

摘要： 目的通过检测螺旋CT肝血流灌注参数评估乙型肝炎肝硬化门静脉高压患者经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)术后肝血流灌注情况。方法 2020年1月—2024年1月安康市人民医院收治的乙型肝炎肝硬化并发门静脉高压症患者116例,在TIPS术前、术后1周进行全肝灌注CT扫描,评价图像质量并利用后处理工作站计算CT灌注参数变化。随访6个月,比较不同预后状态乙型肝炎肝硬化门静脉高压患者CT灌注参数差异。结果 TACE术后1周,乙型肝炎肝硬化并发门静脉高压症患者HAP、PVP、THP及HAPI与TACE术前比较差异有统计学意义(P<0.05)。TACE术后1周乙型肝炎肝硬化并发门静脉高压症患者ALT、Alb、TBil及PT为(32.1±7.4)U/L、(33.1±1.0)g/L、(17.3±2.9)μmol/L及(12.2±0.6)s,与TACE术前[(42.8±8.9)U/L、(32.0±1.1)g/L、(32.6±6.2)μmol/L及(13.4±1.0)s]相比,差异具有统计学意义(P<0.05)。随访6个月,116例患者中死亡17例(14.6%),其中6例(35.3%)死于消化道出血,11例(64.7%)死于肝性脑病。死亡组HAP、THP及HAPI为(23.1±11.6)mL/min×100 mL、(38.0±14.3)mL/min×100 mL及(54.7±19.3)%,均分别显著差于存活组[(30.2±8.9)mL/min×100 mL、(46.2±8.5)mL/min×100 mL及(67.0±14.1)%,P<0.05]。结论应用CT灌注成像评估乙型肝炎肝硬化门静脉高压患者TIPS术前、术后灌注参数变化,了解其血流动力学的差异,为患者术前及疗效评估提供参考。

关键词: 乙型肝炎肝硬化, 门静脉高压, 经颈静脉肝内门体分流术, CT灌注成像

Abstract: Objective To evaluate the hepatic blood perfusion after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatitis B cirrhosis and portal hypertension by using the hepatic blood perfusion parameters of spiral CT. Methods Between January 2020 and January 2024, 116 patients with hepatitis B cirrhosis complicated with portal hypertension were scanned with whole liver perfusion CT before and 1 week after TIPS. The image quality was evaluated and the changes of CT perfusion parameters was calculated by post-processing workstation. After a 6-month follow-up, the differences of CT perfusion parameters in patients with portal hypertension due to hepatitis B cirrhosis in different prognosis were compared. Results Hepatic artery perfusion (HAP), portal vein perfusion (PVP), total hepatic perfusion (THP) and hepatic artery perfusion index (HAPI) [1]in patients with hepatitis B cirrhosis complicated with portal hypertension were significantly different from those before TACE (P<0.05). The levels of alanine aminotransferase (ALT), albumin (Alb), total bilirubin (TBil) and prothrombin time (PT) in patients with hepatitis B cirrhosis complicated with portal hypertension were (32.1±7.4) U/L, (33.1±1.0) g/L, (17.3±2.9) μmol/L and (12.2±0.6) s at 1 week after TACE, compared with the patients in preoperative TACE group [(42.8±8.9) U/L, (32.0±1.1) g/L, (32.6±6.2) μmol/L and (13.4±1.0) s]. The difference was statistically significant (P<0.05). After following up for 6 months, 17 (14.6%) of the 116 patients died, including 6 (35.3%) from gastrointestinal bleeding and 11 (64.7%) from hepatic encephalopathy. HAP, PVP, THP and HAPI in death group were (23.1±11.6) mL/min × 100 mL, (38.0±14.3) mL/min × 100 mL and (54.7±19.3)%, their parameter were significantly lower than those in the survival group [(30.2±8.9) mL/min × 100 mL, (46.2±8.5) mL/min × 100 mL and (67.0±14.1)%, respectively, P<0.05]. Conclusion CT perfusion imaging was used to evaluate the changes of perfusion parameters before and after TIPS in patients with portal hypertension due to hepatitis B cirrhosis, and to understand the hemodynamic differences, so as to provide reference for preoperative and curative effect evaluation of patients.

Key words: Hepatitis B cirrhosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt, CT perfusion imaging

杜欣阳, 史柯. 螺旋CT肝血流灌注参数对乙型肝炎肝硬化门静脉高压患者TIPS术后肝血流灌注的评估[J]. 肝脏, 2025, 30(2): 207-210.

DU Xin-yang, SHI Ke. Evaluation of hepatic blood perfusion parameters using spiral CT after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension[J]. Chinese Hepatolgy, 2025, 30(2): 207-210.

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