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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2024, Vol. 21 ›› Issue (01) : 83 -89. doi: 10.3877/cma.j.issn.1672-6448.2024.01.013

基础研究

超声造影定量评估大鼠70%肝切除后不同类型门静脉狭窄残肝微循环灌注的实验研究
马琳1, 彭驰涵1, 朱晓霞1, 范红霞1, 杨家丽1, 罗燕1,†()   
  1. 1. 610041　成都，四川大学华西医院超声医学科
  • 收稿日期:2022-09-09 出版日期:2024-01-01
  • 通信作者: 罗燕
  • 基金资助:
    水力学与山区河流开发保护国家重点实验室开放课题(SKHL2022)

Quantitative evaluation of hepatic microcirculation perfusion in rats with different types of portal vein stenosis after 70% hepatectomy by contrast-enhanced ultrasound: an experimental study

Lin Ma1, Chihan Peng1, Xiaoxia Zhu1, Hongxia Fan1, Jiali Yang1, Yan Luo1,†()   

  1. 1. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2022-09-09 Published:2024-01-01
  • Corresponding author: Yan Luo
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引用本文：

马琳, 彭驰涵, 朱晓霞, 范红霞, 杨家丽, 罗燕. 超声造影定量评估大鼠70%肝切除后不同类型门静脉狭窄残肝微循环灌注的实验研究[J]. 中华医学超声杂志（电子版）, 2024, 21(01): 83-89.

Lin Ma, Chihan Peng, Xiaoxia Zhu, Hongxia Fan, Jiali Yang, Yan Luo. Quantitative evaluation of hepatic microcirculation perfusion in rats with different types of portal vein stenosis after 70% hepatectomy by contrast-enhanced ultrasound: an experimental study[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(01): 83-89.

目的

应用超声造影（CEUS）定量分析大鼠70%肝部分切除（PH）后不同类型门静脉狭窄（PVS）残肝微循环灌注变化。

方法

将75只SD大鼠随机分为PH组（15只）和PH后中、重度PVS（PVSM、PVSS）组（各30只）。PVS组根据狭窄部位不同分为肝门组和非肝门组（各15只）。各组按术后不同大鼠处死时间（1 d、2 d、3 d、7 d、14 d）分为5个亚组，每组各3只。PH组行70% PH；PVS组在PH组处理基础上于门静脉不同部位行不同程度部分结扎。于术后1、2、3、7、14 d行CEUS检查，对残余肝右侧叶及乳头叶微循环灌注进行定量分析，获取始增时间（AT）、达峰时间（TP）、峰值强度（PI）和曲线下面积（AUC）。采用单因素方差分析法对PH组、PVSM组、PVSS组间残余肝叶微循环灌注参数（AT、TP、PI、AUC）进行比较，组间两两比较采用LSD法或Dunnett's法；对于同一程度PVS组，采用独立样本t检验对肝门组和非肝门组上述参数进行比较，分析不同类型PVS后残肝微循环灌注变化。

结果

不同程度PVS组右侧叶AUC随时间呈递增趋势，PVSM组术后第7天AUC均明显高于术后第1、3天[（4918.54±384.46）dB/s vs（2631.53±120.80）dB/s vs（3117.22±434.33）dB/s]，PVSS组术后第7天AUC明显高于术后第1天[（3892.09±266.81）dB/s vs（2394.68±408.53）dB/s]，差异均具有统计学意义（P=0.014、0.043、0.017）；PVSS组术后第7天乳头叶AT明显延长，高于术后第1、2、3天[（5.18±0.56）s vs（3.33±0.24）s vs（3.10±0.52）s vs（3.55±0.35）s]，差异均具有统计学意义（P=0.007、0.003、0.015）。术后第1天，PVSM组右侧叶PI明显高于PH组[（35.62±2.42）dB vs（25.11±1.60）dB]；术后第7天，PVSS组右侧叶PI和AUC均明显低于PH组和PVSM组[（30.89±0.81）dB vs（39.48±1.22）dB vs（37.03±2.84）dB，（3892.09±266.81）dB/s vs（5383.19±295.45）dB/s vs（4918.54±384.46）dB/s]，差异均具有统计学意义（P=0.016、0.025、0.045、0.018、0.039）。不同程度PVS组乳头叶各灌注参数于术后不同时间差异均无统计学意义（P均>0.05）。术后第7天，PVSs肝门组乳头叶PI明显高于非肝门组[（35.85±1.26）dB vs（30.26±0.87）dB]，差异具有统计学意义（t=3.655，P=0.022）。

结论

CEUS可定量评估大鼠70% PH后不同类型PVS引发的肝微循环灌注改变，重度PVS右侧叶灌注明显降低。同一程度、不同部位PVS局部肝叶微循环灌注可出现不同。

关键词: 门静脉狭窄, 超声造影, 微循环灌注, 定量分析, 鼠
Objective

To quantitatively analyze the changes of microcirculation perfusion in the remnant liver of rats with different types of portal vein stenosis (PVS) after 70% hepatectomy (PH) by contrast-enhanced ultrasound (CEUS).

Methods

Seventy-five Sprague-Dawley rats were randomly divided into a PH group (n=15) and two PVS groups with moderate or severe PVS following PH (PVSM and PVSS groups, n=30 each). According to the stenosis site, the PVS groups were further divided into either a hilar group or a non-hilar group (n=15 each). Each group was divided into 5 subgroups at different postoperative times (1, 2, 3, 7, and 14 d), with 3 rats in each group. PH was induced in all rats by 70% hepatectomy, and PVS was induced by different degrees of partial ligation at different sites of the portal vein following PH. At postoperative 1, 2, 3, 7, and 14 d, CEUS was performed to quantitatively analyze the hepatic microcirculation perfusion of the residual right lobe and papillary lobe based on the arrival time (AT), time to peak (TP), peak intensity (PI), and area under the curve (AUC). Single factor analysis of variance was used to compare the residual hepatic microcirculation perfusion parameters (AT, TP, PI, and AUC) among different groups. For groups with PVS of the same severity at different sites, independent sample t-tests were used to compare the above parameters to explore the microcirculation perfusion changes of the residual liver in different types of PVS.

Results

The AUC of the residual right lobe in the PVS groups increased with time. The AUC in the PVSM group was significantly higher at postoperative 7 d than at 1 d and 3 d [(4918.54±384.46) dB/s vs (2631.53±120.80) dB/s and (3117.22±434.33) dB/s, P=0.014 and 0.043, respectively], and the AUC in the PVSS group was significantly higher at postoperative 7 d than at 1 d [(3892.09±266.81) dB/s vs (2394.68±408.53) dB/s, P=0.017]. The AT of the papillary lobe at postoperative 7 d was longer than that at 1, 2, and 3 d [(5.18±0.56) s vs (3.33±0.24) s, (3.10±0.52) s, and (3.55±0.35) s, P=0.007, 0.003, and 0.015, respectively]. At postoperative 1 d, the right-lobe PI in the PVSM group was significantly higher than that of the PH group [(35.62±2.42) dB vs (25.11±1.60) dB, P=0.016], and at postoperative 7 d, the right-lobe PI and AUC in the PVSS group were significantly lower than those of the PH and PVSM groups [PI: (30.89±0.81) dB vs (39.48±1.22) dB and (37.03±2.84) dB, P=0.025 and 0.045, respectively; AUC: (3892.09±266.81) dB/s vs (5383.19±295.45) dB/s and (4918.54±384.46) dB/s, P=0.018 and 0.039, respectively]. There was no significant difference in papillary-lobe AT, TP, PI, or AUC among the PVS groups (P>0.05). At postoperative 7 d, the papillary-lobe PI in the hilar group was significantly higher than that of the non-hilar group [(35.85±1.26) dB vs (30.26±0.87) dB, t=3.655, P=0.022].

Conclusion

CEUS could quantitatively evaluate the hepatic microcirculation perfusion changes induced by different types of PVS following 70% PH in rats, and the right-lobe perfusion in severe PVS is significantly reduced. The microcirculation perfusion of hepatic lobes in rats with PVS of the same severity at different stenosis sites may be different.

Key words: Portal vein stenosis, Contrast-enhanced ultrasound, Microcirculation perfusion, Quantitative analysis, Rat
图1 大鼠部分肝切除后残余右侧叶及乳头叶超声造影定量分析图。图a：右侧叶及乳头叶肝实质时间-强度曲线绘制；图b：右侧叶及乳头叶微循环主要灌注参数
表1 不同程度PVS组大鼠肝右侧叶微循环灌注变化情况（）
参数/分组 只数 1 d 2 d 3 d 7 d F值 P值
AT（s）
PH组 15 3.57±0.43 6.67±1.30 6.20±0.91 4.00±0.15 2.494 0.134
PVSM组 30 3.45±0.45 4.82±0.36 3.82±0.83 4.78±0.67 1.288 0.306
PVSS组 30 3.83±0.33 4.00±0.52 3.98±0.57 3.92±0.42 0.026 0.994
F值 0.258 3.822 2.171 0.799
P值 0.777 0.052 0.157 0.472
TP（s）
PH组 15 40.87±12.91 47.73±10.23 41.23±7.63 34.37±6.57 0.320 0.811
PVSM组 30 33.78±5.23 35.43±5.60 31.70±3.75 32.82±3.38 0.183 0.906
PVSS组 30 24.32±3.30 35.33±4.41 24.53±1.96 33.11±4.25 3.054 0.052
F值 1.687 1.020 3.842 0.026
P值 0.226 0.390 0.051 0.974
PI（dB）
PH组 15 25.11±1.60 29.77±1.58 29.17±4.05 39.48±1.22Ⅰ,Ⅱ,Ⅲ 6.468 0.016
PVSM组 30 35.62±2.42a 30.83±2.97 30.39±2.59 37.03±2.84 0.933 0.443
PVSS组 30 30.52±2.24 35.68±1.37 32.25±2.08 30.89±0.81a,b 1.063 0.387
F值 4.047 1.783 0.300 4.121
P值 0.045 0.210 0.746 0.043
AUC（dB/s）
PH组 15 2645.57±275.67 3653.00±128.94 2939.86±515.83 5383.19±295.45Ⅰ,Ⅱ,Ⅲ 10.693 0.004
PVSM组 30 2631.53±120.80 3372.69±632.74 3117.22±434.33 4918.54±384.46Ⅰ,Ⅲ 3.218 0.045
PVSS组 30 2394.68±408.53 4447.75±319.52 3256.95±660.38 3892.09±266.81a,b,I 4.609 0.013
F值 0.555 1.434 0.061 4.615
P值 0.588 0.276 0.942 0.033
表2 不同程度PVS组大鼠肝乳头叶微循环灌注变化（）
参数/分组 只数 1 d 2 d 3 d 7 d F值 P值
AT（s）
PH组 15 4.07±0.20 3.93±0.27 5.93±0.92 3.90±0.55 3.054 0.092
PVSM组 30 3.63±0.63 3.05±0.75 4.68±0.68 4.07±0.33 1.252 0.317
PVSS组 30 3.33±0.24 3.10±0.52 3.55±0.35 5.18±0.56Ⅰ,Ⅱ,Ⅲ 4.746 0.012
F值 0.473 0.423 3.136 2.090
P值 0.634 0.664 0.080 0.166
TP（s）
PH组 15 33.60±4.29 40.90±8.17 28.53±4.82 26.30±0.82 1.539 0.278
PVSM组 30 28.27±4.69 34.67±5.31 29.62±3.82 30.13±4.71 0.354 0.786
PVSS组 30 27.69±2.27 40.98±3.87 25.25±3.87 27.88±3.91 0.334 0.722
F值 1.862 0.504 0.334 0.174
P值 0.198 0.617 0.722 0.842
PI（dB）
PH组 15 27.17±3.12 32.96±2.78 26.95±0.89 36.86±1.31Ⅰ,Ⅲ 4.619 0.037
PVSM组 30 34.62±2.35 32.01±3.23 31.63±1.97 34.60±1.44 0.479 0.700
PVSS组 30 33.46±4.21 35.06±1.02 30.63±1.96 32.72±1.43 0.548 0.655
F值 0.932 0.442 1.133 1.579
P值 0.421 0.653 0.354 0.246
AUC（dB/s）
PH组 15 2449.61±400.91 3693.52±720.65 2583.39±483.90 4723.08±222.54Ⅰ,Ⅲ 4.705 0.035
PVSM组 30 2784.64±307.36 3574.32±706.87 2899.21±390.71 3966.48±403.71 1.386 0.276
PVSS组 30 2856.81±650.93 3715.64±317.01 2517.52±717.40 3737.14±242.55 1.382 0.277
F值 0.126 0.223 0.187 1.709
P值 0.883 0.803 0.832 0.222
表3 术后第7天同一程度、不同部位肝右侧叶及乳头叶微循环灌注变化（）
分组 只数 AT（s） TP（s） PI（dB） AUC（dB/s）
右侧叶
PVSM肝门 3 5.17±1.05 36.03±6.42 39.17±3.39 5335.15±208.09
PVSM非肝门 3 4.40±1.01 29.60±2.38 34.89±4.94 4501.94±722.63
t值 0.526 0.940 0.715 1.108
P值 0.627 0.400 0.514 0.330
PVSS肝门 3 3.47±0.52 34.93±6.02 30.28±1.08 3618.78±501.48
PVSS非肝门 3 4.37±0.65 31.30±7.11 31.49±1.33 4165.39±172.47
t值 1.084 0.390 0.704 1.031
P值 0.339 0.716 0.520 0.361
乳头叶
PVSM肝门 3 4.43±0.43 37.60±7.38 35.36±2.55 4159.62±714.20
PVSM非肝门 3 3.70±0.46 22.67±0.95 33.83±1.80 3773.33±517.22
t值 1.163 2.007 0.493 0.438
P值 0.310 0.178 0.648 0.684
PVSS肝门 3 4.50±0.25 25.87±2.67 35.85±1.26 3740.20±463.14
PVSS非肝门 3 5.87±1.01 29.90±8.06 30.26±0.87 3734.07±282.20
t值 1.308 0.475 3.655 0.011
P值 0.261 0.660 0.022 0.992
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