组织结构声学定量技术无创评估TIPS联合PTVE疗效

Non-invasive evaluation on therapeutic effect of transjugular intrahepatic portosystemic shunt and percutaneous transhepatic varices embolization using acoustic structure quantification method

摘要:

目的：探讨组织结构声学定量分析（acoustic structure quantification，ASQ）技术在无创评价经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt，TIPS）联合经皮肝穿胃冠状静脉栓塞术（percutaneous transhepatic varices emboliza－tion，PTVE）疗效的临床应用价值。方法：应用ASQ技术对30例正常人及30例肝硬化门静脉高压预行TIPS联合PTVE患者手术前后肝、脾分别定量分析，比较手术前后肝、脾的ASQ卡方值直方图和ASQ定量相关参数：众数、均值、标准差以及蓝红2色直方图曲线下面积比；并在手术过程中测量门静脉压（portosystemic pressure gradient，PPG）；比较手术前后肝、脾ASQ定量参数值的变化及与PPG的相关性。结果：PPG术前组（28.71±4.81） mmHg与术后组（18.30±4.73） mmHg比较，差异具有统计学意义（P<0.05）；脾脏Red Mode、Red Ave、Red SD、FD ratio、Blue Mode、Blue Ave、Blue SD各参数值正常对照组分别为（99.60±2.15）、（102.25±2.22）、（13.62±1.70）、（0.13±0.11）、（120.90±6.29）、（132.57±15.98）、（27.94±13.65），术前组上述参数值分别为（103.21±1.98）、（107.52±2.51）、（18.48±1.41）、（0.18±0.07）、（125.25±2.86）、（146.57±9.03）、（37.64±10.21），术前组脾ASQ各定量参数均大于正常对照组（P<0.05）；术后组脾ASQ各定量参数分别为（101.66±1.97）、（105.24±2.04）、（16.56±1.49）、（0.15±0.09）、（122.96±5.56）、（137.96±14.46）、（31.45±12.49），术后各参数值均小于术前，各组之间具有统计学差异（P<0.05）；肝ASQ各定量参数值在术前组分别为（117.81±3.23）、（120.70±3.27）、（19.70±1.07）、（0.67±0.28）、（136.05±4.62）、（148.68±7.03）、（33.68±7.36），术后组各参数值分别为（118.01±3.35）、（120.9±3.58）、（19.54±1.40）、（0.66±0.30）、（135.26±4.38）、（148.42±7.65）、（33.73±6.30），术前组与术后组比较差异无统计学意义（P >0.05）。脾ASQ各定量参数值与PPG呈高度正相关（r值分别为0.299、0.331、0.451、0.848、0.961、0.318、0.881，P均<0.05）；然而肝ASQ各定量参数值与PPG无相关性（r值分别为0.194、0.174、0.045、0.169、0.128、0.105、0.136，P均>0.05）；正常对照组、术前组、术后组脾脏指数（spleen index，SI）分别为（18.21±1.42） cm2、（45.23±12.32） cm2、（35.66±11.70） cm2，正常对照组与术前、术前组与术后组脾指数比较差异均有统计学意义（P<0.05）。结论：ASQ技术测量的脾ASQ各定量参数值可用于无创定量监测TIPS联合PTVE术前、术后门静脉压的变化情况、评价手术疗效，具有良好的临床应用前景。

Abstract:

Objective：To explore the diagnostic value of acoustic structure quantification（ASQ） technique in noninvasive assessment of transjugular intrahepatic portosystemic stent（TIPS） and per－cutaneous transhepatic varices embolization（PTVE）. Methods：Quantitative assessment of 30 normal subjects and 30 patients who underwent TIPS and PTVE for treatment of portal hyper－tension（PHTN）was held by ASQ. The portal vein pressure was measured while placing the TIPS and PTVE. ASQ parameters of the plural，mean，standard deviation，the ratio of blue and red color histogram curve area and the chi-square value were com－pared. The correlation between ASQ parameters of the spleen and the liver and portal venous pressure was analyzed. Results：There were significant differences in portal vein pressure pre and post TIPS and PTVE（P<0.05）. ASQ quantitative parameters were Red Mode，Red Ave，Red SD，FD ratio，Blue Mode，Blue Ave，Blue SD. The values of ASQ quantitative parameters of the spleen were high－er in PHTN pre TIPS and PTVE group than in health control group （P<0.05）. The values of ASQ quantitative parameters of the spleen were higher in PHTN pre TIPS and PTVE group than in post TIPS and PTVE group（P<0.05）. There was no difference in val－ues of ASQ quantitative parameters of the live pre and post TIPS and PTVE （P>0.05）. Significant linear correlation was found be－tween the ASQ quantitative parameters of the spleen and portal vein pressure（r=0.299，0.331，0.451，0.848，0.961，0.318 and 0.881，all P<0.05）. But the ASQ quantitative parameters of liver were not correlated with the portal venous pressure（r=0.194，0.174，0.045，0.169，0.128，0.105 and 0.136，all P>0.05）. There were significant differences in spleen index between healthy subjects and patients with PHTN（P<0.05），as well as between pre and post TIPS and PTVE（P<0.05）. Conclusion：The ASQ quantitative parameters of the spleen could be used as non-invasive method for quantitatively monitoring the change of portal vein pressure pre and post the TIPS and PTVE.