应用化疗药及内分泌药后兔肝的超声表现及病理改变的对照研究

目的 观察实验兔应用化疗药及内分泌药后血生化改变、兔肝超声表现及兔肝病理所见,并进行对照研究,重点观察肝脂肪损害的情况。 方法 雌性新西兰大耳白兔40只，随机分为4组，普通饲料+淀粉组（A组）、高脂饲料组（B组）、表阿霉素+环磷酰胺+三苯氧胺+普通饲料组（C组）、表阿霉素+环磷酰胺+三苯氧胺+高脂饲料组（D组），每组10只。于实验前测定肝功能及血脂,对兔肝行常规超声检查及兔肝实质声辐射力脉冲成像测定。A组、B组喂养6个月，C组、D组应用6个周期化疗药及3个周期的内分泌药后再次行上述检查，比较实验前后的肝功能、血脂、常规超声表现及剪切波速度值,最后行兔肝病理检查。 结果 实验室检查，肝功能实验后B、C、D组天冬氨酸转氨酶（aspartate aminotransferase，AST）及丙氨酸转氨酶（alanine aminotransferase，ALT）均较实验前增高,且实验后B、C、D组AST及ALT值均高于A组，C组和D组 AST及ALT值均高于B组,D组ALT值又高于C组，差异均有统计学意义（P＜0.05）；血脂实验后B、C、D组总胆固醇（total cholesterol，TC）及三酰甘油（triglyceride，TG）均较实验前增高，且实验后B、C、D组TC及TG值均高于A组，B、D组 TC及TG值高于C组, D组TC值又高于B组，差异均有统计学意义（P＜0.05）。超声检查，A组实验前后声像图无明显变化，实验后B组显示肝体积稍增大，肝实质回声致密增强，C组显示肝包膜欠光滑，肝实质回声稍增强不均，胆管及门脉管壁回声稍增强，D组实验后除了C组超声表现外，还可见肝实质致密增强；B、C、D 组实验后剪切波速度较实验前增加且均大于A组，差异有统计学意义（P＜0.05）。病理结果，A组实验后未见异常改变；B组实验后可见中-重度脂肪变性、轻-中度水肿；C组实验后可见轻度脂肪变性，中至重度水肿，局灶性淤血及淤胆，少-中量炎细胞浸润，局限性纤维化；D组实验后除了可见C组的主要改变外，还可见肝结节再生。 结论 单纯应用化疗药及内分泌药家兔尽管肝病理上出现了脂肪变性损害，但在超声上未出现明显脂肪肝图像，而单纯应用高脂饲料和应用化疗药+内分泌药+高脂饲料的家兔出现了较为明显的脂肪肝超声图像及病理改变，表明高脂饲料对产生脂肪肝起主要作用。声辐射力脉冲成像技术对上述药物所造成的肝损害定量评价有一定价值。

Compared study on ultrasonic appearances and pathologic features of rabbit liver after utilization of chemotherapeutants and endocriminal medication

Objective〖HTSS〗To observe and study the ultrasonic appearances and pathologic features of rabbit liver after utilization of chemotherapeutants and endocriminal medicine，with a focus on fatty liver lesion. 〖WTHZ〗Methods〖HTSS〗Forty female Newzaland rabbits were divided into 4 groups, group A（standard diet+starch）, group B(high-fat diet), group C(epirubicine+cyclophosphamide+tamoxifen+standard diet), group D(epirubicine+cyclophosphamide+tamoxifen+high-fat diet), 10 in each group. Prior to experiment， liver function, blood lipids, conventional ultrasound, shear wave velocity of hepatic parenchyma were executed . After 6-month feeding for group A and group B, and after 6-cycle chemotherapy followed by 3-month tamoxifen for group C and group D , above-mentioned examinations were carried out again. Finally rabbit liver pathology was performed. 〖WTHZ〗Results〖HTSS〗LaboratoryLiver functionAfter the experiment, the values of aspartate aminotransferase（AST） and alanine aminotransferase（ALT） in group B, C ,D were eleveted, the values of AST and ALT in group B, C and D were higher than that of group A, the values of AST and ALT in group C and D were higher than that of group B, the ALT value of group D was higher than that of group C，the above differences were statistically significant(P＜0.05）. Serum lipidsAfter the experiment, the values of total cholesterol(TC) and triglyceride(TG） in group B,C,D were eleveted, the values of TC and TG in group B, C, D were higher than that of group A, the values of TC and TG in group B, D were higher than that of group C, the TC value of group D was higher than that of group B，the above differences were statistically significant(P＜0.05）. UltrasoundAfter the experiment, there were no abnormal sonographic appearances in group A. After the experiment,group B showed mild enlargement of the hepatic size, enhanced and dense parenchymal echoes; group C showed normal liver size, but somewhat unsmooth capsule, lightly enhanced and heterogenous panrenchymal echoes; Group D showed obvious and dense echogenicity in liver parenchyma besides group C's characteristics. After the experiment, the shear-wave velocity in group B, C, D were elevated，the values of group B,C,D were higher than that of group A, the above differences were statistically significant(P＜0.05）. PathologyAfter the experiment，group A showed no abnorrnal pathologic findings. Group B showed moderate to severe steatosis, mild to moderate hydropic swelling. Group C showed mild steatosis, moderate to severe hydropic swelling, focal cholestasis and blood stasis, mild to moderate inflammation cell infiltration， focal fibrosis. Group D developped some regenerative nodules besides group C's main findings. 〖WTHZ〗Conclusion〖HTSS〗Although the rabbits which only recieved the chemotherapy and tamoxifen showed some steatosisbesides hepatic celullar and parenchymal lesions, they did not show ultrasonographically remarkable fatty liver sonogram, 〖JP2〗however those rabbits which recieved high-fat diet or chemotherapy+tamoxifen+〖JP〗high-fat diet showed obvious fatty-liver sonographic characteristics. The fact demonstrates that high-fat diet plays a key role in forming fatty liver. Acoustic radiation force impulse imaging(ARFI) has some values in evaluating the hepatic lesions after the administration of chemotherapy and endocrine medication or high-fat diet.