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目的 :探讨全肝灌注+肝脏体积一站式检查评价肝硬化患者肝脏储备功能的应用价值。方法 :肝功能正常组20例及肝硬化组23例均行256层CT全肝灌注和常规上腹部增强扫描,将灌注数据和增强门脉期薄层数据分别经Functional软件及肝段分析处理后,得出全肝灌注参数值和体积值,取各段灌注参数平均值作为全肝灌注参数值。对肝硬化组应用Child-pugh(C-P)分级进行分组,比较肝功能正常组与Child A、B、C各组间肝脏体积、全肝灌注参数的差异;并计算得出综合指标,分别与肝功能C-P分级分数进行相关性分析。结果:随着肝功能受损程度的加重,肝动脉灌注量(hepatic arterial perfusion,HAP)、肝动脉灌注指数(hepatic arterial perfusion index,HAPI)呈逐级上升,门静脉灌注量(hepatic portal perfusion,HPP)、肝总灌注量(total liver perfusion,TLP)、门静脉灌注指数(hepatic portal perfusion index,HPPI)呈逐级递减,相关性系数分别为:rHAP=0.382,rHAPI=0.841,rHPP=-0.761,rTLP=-0.594,rHPPI=-0.846;肝脏体积(liver volume,LV)、单位体表面积肝脏体积(liver volume per body surface area,LVs)呈逐级递减,rLV=-0.875,rLVs=-0.933;单位体表面积肝脏体积-门静脉灌注指数(volume hepatic portal perfusion index per body surface area,VHPPILs)呈逐级递减,rVHPPILs=-0.945。结论 :肝血流灌注及肝体积的改变与肝硬化临床分级相关,VHPPILs综合指标更全面地诠释了肝脏储备功能,可用于定量评估肝硬化患者肝脏整体储备功能。
Objective: To investigate the value of whole liver perfusion + liver volume one-stop examination in evaluating liver reserve function in patients with liver cirrhosis. Methods: Twenty-six-slice CT whole liver perfusion and conventional upper abdominal enhancement scanning were performed in 20 patients with normal liver function and 23 patients with cirrhosis. The perfusion data and enhanced portal venous lamellar data were analyzed by functional software and liver segment analysis , Obtained the value of the whole liver perfusion parameters and volume values, taking the average perfusion parameters of each segment as the value of the whole liver perfusion parameters. Child-pugh (CP) grading was used to classify the liver cirrhosis group, and the difference of liver volume and whole liver perfusion parameters between normal liver function group and Child A, B, C groups was compared; and the comprehensive index was calculated, Correlation analysis of functional CP grade scores. Results: With the aggravation of hepatic dysfunction, hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HAPI) increased gradually, and the amount of portal vein perfusion (HPP) ), Total liver perfusion (TLP) and hepatic portal perfusion index (HPPI) decreased gradually with the correlation coefficients of rHAP = 0.382, rHAPI = 0.841, rHPP = -0.761, rTLP = -0.594, rHPPI = -0.846; liver volume (LV) and unit volume decreased gradually, rLV = -0.875, rLVs = -0.933; The volume hepatic portal perfusion index per body surface area (VHPPILs) decreased gradually with rVHPPILs = -0.945. Conclusion: The change of hepatic perfusion and liver volume is related to the clinical grade of cirrhosis. The comprehensive index of VHPPILs interprets the function of liver reserve more comprehensively and can be used to quantitatively assess the overall liver reserve function in cirrhotic patients.