CT灌注成像评估心脏死亡捐献供肝质量的临床研究

目的研究CT灌注成像的参数与心脏死亡捐献（DCD）肝脏移植术后肝功能指标的相关性，并探讨CT灌注成像技术评估供肝质量的临床应用价值。 方法本组研究纳入8例DCD供肝肝移植术受体，均为男性，平均年龄（48.8±8.0）岁；其中肝细胞癌6例，乙型肝炎后肝硬化2例，术后均未发现血管及胆道并发症。于术后第7天进行CT灌注成像检查，测量肝动脉灌注流速（AF）、门静脉灌注流速（PF）、肝动脉灌注指数（PI）、肝动脉峰值达到时间（APT）及门静脉峰值达到时间（PPT），结合受体接受检查当天、术后1 d、术后7 d、术后2周、术后1月和术后2月的胆红素（TBIL）、肝酶（ALT、AST、ALP、GGT）、蛋白合成（ALB、PA）及凝血功能（PT、PTA、APTT、INR）等肝功能血清学指标进行相关性分析。 结果CT灌注成像的参数中AF、APT、PPT与受体术后1月的转氨酶（ALT或AST）具有相关性，其中AF与ALT呈正相关（r=0.842，P<0.01），AST与APT（r=-0.713，P<0.05）、PPT（r=-0.756，P<0.05）呈负相关；PF与受体术后2月的AST呈正相关（r=0.728，P<0.05）。 结论CT灌注成像参数与DCD来源供肝移植术后1~2个月的肝功能具有良好的相关性，提示该检查可能成为评价DCD供肝质量及移植术后肝功能恢复的客观临床指标。

Use of computed tomography perfusion imaging in evaluating the quality of liver allografts from donation after cardiac death

ObjectiveTo investigate the correlation between postoperative function of liver allografts from donation after cardiac death (DCD) and hepatic perfusion parameters by CT perfusion imaging. MethodsCT perfusion imaging was performed in eight male cases on day 7 postoperatively after liver transplantation from DCD donors, including six patients with hepatocellular carcinoma and two patients with cirrhosis after chronic hepatitis B. The CT perfusion imaging parameters, including AF (arterial flow), PF (portal flow), PI (perfusion index), APT (arterial peek time), PPT (portal peek time), were calculated for correlation analysis with serological liver function tests on postoperative day 1, day 7, day 14, day 30 and day 60, respectively. ResultsAF, APT and PPT was correlated with ALT or AST the first month after surgery. AF was positively related with ALT (r=0.842, P<0.01), while AST was negatively correlated with (APT) (r= 0.713, P<0.05) and PPT (r= 0.756, P<0.05) in post-transplantation. PF was positively related with AST (r=0.728, P<0.05) 60 days after the transplantation. ConclusionThe parameters of CT perfusion imaging are significantly correlated with postoperative liver function tests,suggesting CT perfusion imaging can be a useful and objective test for evaluating the quality of liver allografts from DCD.