摘要
目的:应用二维剪切波弹性成像技术(2D-SWE)评估肝移植术后糖尿病(PTDM)患者肝脏及脾脏弹性,以评价PTDM与移植肝和脾脏硬度关系。方法:选取2020年10月—2021年8月肝移植术后>6月随访患者60例,根据肝移植术后是否发生糖尿病分为肝移植术后不合并糖尿病组30例(B组)及肝移植术后合并糖尿病组30例(C组),并选取30例健康志愿者作为对照组(A组),对照组无肝病史,无家族病史及糖尿病史且各项指标均处于正常范围内。收集临床及相关超声资料并应用2D-SWE技术将测得的肝、脾弹性值(LSM、SSM)进行分析比较。结果:(1)方差分析结果显示,与A组比较,B、C组肝脏右斜径、肝动脉峰值血流速度、门静脉血流速度、门静脉管径、脾长、脾厚、脾静脉内径具有显著性差异(P均<0.05);C组与A组比较,C组与B组比较,空腹血糖值均具有显著性差异(P均<0.05);C组与B组比较,肝移植术后病程无显著性差异(P>0.05);B组与A组比较、C组与A组比较、C组与B组比较,LSM均具有显著性差异(P均<0.05);与A组比较,B组、C组SSM均具有显著差异性(P均<0.05);(2)Spearman相关性分析显示,B、C两组LSM均与门静脉血流速度成正相关(r_(s)=0.390;0.467,P均<0.05),LSM均与肝动脉峰值血流速度成正相关(r_(s)=0.381;0.524,P均<0.05);(3)多元回归分析研究显示,C组空腹血糖值、年龄、肝移植术后病程是LSM的独立影响因素。结论:PTDM使移植肝硬度值较无糖尿病者增加,高血糖可能促进移植肝发生纤维化;移植肝血流动力学状态与LSM有关,二者呈正相关关系。通过2D-SWE检测能发现三组之间肝脏硬度差异,并较准确评估PTDM患者肝脾弹性状态。2D-SWE技术对肝移植术后肝脏硬度进行检测,逐步成为评价肝移植术后预后新的检测方法。
Objective:To evaluate the elasticity change of liver and spleen in patients with post-liver transplantation diabetes mellitus(PTDM)by two-dimensional shear wave elastography(2D-SWE),and to evaluate the relationship between PTDM and the stiffness of the transplanted liver and spleen.Methods:Sixty patients were followed up for more than 6 months after liver transplantation from October 2020 to August 2021.According to whether diabetes occurred after liver transplantation,there were 30 patients without diabetes after liver transplantation(group B)and 30 patients with diabetes after liver transplantation(group C),and 30 healthy volunteers were selected as control group(group A).In the control group,there was no history of liver disease,no family history and diabetes history,and all the indexes were in the normal range.We collected clinical and related ultrasound data and apply 2D-SWE technology to analyze and compare the stiffness measurement of liver and spleen(LSM,SSM).Results:(1)Compared with group A,the results of analysis of variance showed that there were significant differences in right oblique diameter of liver,peak systolic velocity of hepatic artery,velocity of portal vein,diameter of portal vein,length,width and diameter of splenic vein in group B and C(P0.05).Comparing group C with group A,and comparing group C with group B,the fasting plasma glucose levels are significantly different(P0.05).There were no significant differences in the course of disease after liver transplantation between group C and group B(P0.05).Comparison between group B and group A,group C and group A,group C and group B,LSM all have significant differences(P0.05).(2)Spearman correlation analysis showed that LSM of group B and C were both positively correlated with velocity of portal vein(Spearman's r=0.390;0.467,all of P0.05),both positively correlated with peak velocity of hepatic artery(Spearman's r=0.381;0.524,all of P 0.05).(3)Multivariate regression analysis showed that fasting plasma glucose value,age and course of disease after liver transplantation were independent influencing factors of LSM in group C.Conclusion:PTDM increased the stiffness of transplanted liver compared with those without diabetes,and hyperglycemia may promote the fibrosis of transplanted liver.In addition,the hemodynamic state of transplanted liver is positively correlated with LSM.The 2D-SWE test can detect differences in liver stiffness among the three groups,and more accurately assess the elastic state of the liver and spleen in patients with PTDM.2D-SWE technology for the detection of liver stiffness after liver transplantation has gradually become a new detection method for evaluating the prognosis after liver transplantation.
作者
林奇华
姚松辰
胡滨
高林
LIN Qi-hua;YAO Song-chen;HU Bin;GAO Lin(Department of Ultrasound,the Fourth Hospital of China Medical University,Shenyang 110032,China;Department of Ultrasound,the Second Hospital of Dalian Medical University,Dalian Liaoning 116021,China;Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2023年第8期575-579,共5页
Journal of China Clinic Medical Imaging
关键词
肝移植
糖尿病
超声检查
Liver Transplantation
Diabetes Mellitus
Ultrasonography
