超声造影评价睾丸微血管损伤的实验研究

摘要

Objective To explore the way of contrast-enhanced ultrasound(CEUS)and quantitative analysis technology to assess testicular microvascular ischemia-reperfusion inj ury.Methods Twenty-four healthy adult rabbits were randomly divided into the control group and the microvascular mild,moderate, serve ischemic inj ury group (group Ⅰ,including group Ⅰ1 ,Ⅰ2 ,Ⅰ3 ).The spermatic cord of the control group were threaded but not ligated.The group Ⅰ1 ,Ⅰ2 ,Ⅰ3 were reperfused 2 h after 2 h,4 h,6 h complete testicular ischemia respectively.The ultrasound contrast angiographic parameters of each group were analyzed by the quantitative analysis techniques,including peak intensity(PI),time to peak(TP),slope,mean transmit time(MTT),DT/2 and area.The levels of plasma vWF,NO and ET-1 were tested after the CEUS. The pathological changes of the ipsilateral testicular were observed by the HE and immunohistochemical staining.Statistical analysis was performed by SPSS 13.0 software.Results Preoperativeiy,each parameter of the experimental group and the control group showed no statistical significance (P > 0.05 ). Postoperatively,the PI,slope,area of the group Ⅰ1 increased significantly,while the TP,MTT were prolonged(P <0.05).Contrast time-intensity curve was significantly higher peak and retrusion.The groupⅠ2's PI,slope,area increased further,DT/2 was significantly prolonged,but TP significantly reduced (P <0.05).The contrast curve significantly increased,forward and decreased slowly.The contrast curves of the group Ⅰ3 was approximate a straight line.The vWF,NO,ET-1 levels of each experimental group were significantly higher than those in control group (P <0.05),among them,the levels of group Ⅰ2 were the highest (P <0.05 ).With the aggravation of ischemia,the testicular capillaries expansion,erythrocyte sedimentation,leakage,infiltration of inflammatory cells,MMP-9 expression in vascular basement membrane gradually increased.Conclusions The CEUS and quantitative analysis techniques can effectively evaluate testicular microvascular inj ury.%目的：探讨超声造影及其量化分析技术评价睾丸缺血再灌注微血管损伤的方法。方法将24只成年健康大白兔随机分为对照组和微血管轻、中、重度缺血损伤组(Ⅰ组,包括Ⅰ1、Ⅰ2、Ⅰ3组),每组6只。对照组暴露精索后穿线但不结扎,Ⅰ1、Ⅰ2、Ⅰ3组术侧睾丸分别完全缺血2h、4h、6h 后,复灌注2 h。术前、术后分别进行双侧睾丸超声造影,分析各组造影参数：峰值强度(PI)、达峰时间(TP)、曲率(Slope)、平均渡越时间(MTT)、峰值减半时间(DT/2)和曲线下面积(Area)的变化。各组造影结束后,实验室检测血浆vWF、NO、ET-1含量。取术侧睾丸,行 HE 染色及免疫组化检查,对比观察各组病理变化。使用 SPSS13.0软件进行统计学分析。结果术前各实验组、对照组间术侧睾丸超声造影各参数无显著差别(P >0.05)。术后,Ⅰ1组造影参数 PI、Slope 显著升高,TP、MTT 明显延长,Area 显著增大,与对照组相比有显著差别(P <0.05),造影时间-强度曲线峰值明显升高、后移。Ⅰ2组造影参数 PI、Slope 进一步升高,DT/2显著延长,TP 明显缩短,Area 进一步增大,与对照组、Ⅰ1组相比差异有统计学意义(P <0.05),造影曲线明显升高、前移且下降缓慢。Ⅰ3组术侧睾丸实质始终未见显影,造影曲线近似一条直线。各实验组血浆vWF、NO、ET-1含量均较对照组显著增高(P <0.05),以Ⅰ2组含量最高,较Ⅰ1、Ⅰ3组显著升高(P <0.05)。病理检查为各实验组随缺血程度加重,睾丸微血管扩张,红细胞淤积漏出、炎症细胞浸润逐渐增多,血管基底膜 MMP-9表达逐渐增强。结论超声造影及其量化分析技术能够有效评价睾丸微血管损伤的程度。