吲哚菁绿清除试验对乙型肝炎肝硬化患者肝脏储备功能的评估价值

赖瑞敏; 王明芳; 朱月永

doi:10.3969/j.issn.1001-5256.2016.09.021

吲哚菁绿清除试验对乙型肝炎肝硬化患者肝脏储备功能的评估价值

DOI: 10.3969/j.issn.1001-5256.2016.09.021

福建医科大学附属第一医院肝病中心

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中图分类号: R575.2;R512.62
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出版历程
- 出版日期: 2016-09-20

Value of indocyanine green test in evaluating liver reserve function in patients with hepatitis B cirrhosis

Liver Research Center, The First Affiliated Hospital of Fujian Medical University

摘要

摘要: 目的通过吲哚菁绿（ICG）清除试验评估乙型肝炎肝硬化患者肝脏储备功能,探讨ICG清除试验与Child-TurcottePugh（CTP）分级和MELD评分评价肝功能之间的关系。方法收集福建医科大学附属第一医院2012年1月-2015年1月住院的乙型肝炎肝硬化患者127例,进行ICG清除试验,计算患者的ICG血浆清除率值（K值）、有效肝血流量（EHBF）、ICG 15 min滞留率（ICG R15）,以及CTP分级和MELD评分。组间比较采用方差分析,进一步两两比较采用LSD-t检验;相关性比较采用Spearman等级相关性分析;采用受试者工作特征曲线下面积（AUC）比较肝脏储备功能。结果乙型肝炎肝硬化患者CTP分级:A级患者63例,B级患者45例,C级患者19例。随着CTP分级升高,ICG R15逐渐增高,而EHBF和K值则逐渐降低,差异均有统计学意义（F值分别为146.96、91.26、40.94,P值均分别为0.001、0.003、0.005）。在评价肝功能方面ICG R15与MELD评分及CTP分级呈正相关（r值分别为0.525、0.838,P值均<0.01）,与EHBF及...
- 肝炎,乙型 /
- 肝硬化 /
- 吲哚花青绿
Abstract: Objective To evaluate liver reserve function in patients with hepatitis B cirrhosis using indocyanine green( ICG) clearance test,and to investigate the correlation of ICG clearance test with Child- Turcotte- Pugh( CTP) class and the Model for End- Stage Liver Disease( MELD) score in evaluating liver function. Methods A total of 127 patients with hepatitis B cirrhosis who were hospitalized in The First Affiliated Hospital of Fujian Medical University from January 2012 to January 2015 were enrolled. ICG clearance test was performed for all the patients,and the ICG plasma clearance( K value),effective liver blood flow( EHBF),and ICG retention at 15 minutes( ICG R15)were calculated. CTP class and MELD score were also determined. An analysis of variance was used for comparison between groups,the least significant difference t- test was used for comparison between any two groups,Spearman rank correlation was performed for correlation analysis,and the area under the receiver operating characteristic( ROC) curve was used to compare liver reserve function. Results Among all the patients with hepatitis B cirrhosis,63 had CTP class A,45 had CTP class B,and 19 had CTP class C hepatitis B cirrhosis. With the increasing CTP class,ICG R15 gradually increased,while EHBF and K value gradually decreased( F = 146. 96,91. 26 and 40. 94,P =0. 001,0. 003 and 0. 005). In the evaluation of liver function,ICG R15 was positively correlated with MELD score and CTP class( r = 0. 525 and 0. 838,both P < 0. 01) and was negatively correlated with EHBF and K value( r =- 0. 703 and- 0. 901,both P < 0. 01). The area under the ROC curve was 0. 85 for ICG R15 and 0. 65 for MELD score. Conclusion ICG test can accurately and dynamically reflect liver reserve function,and ICG R15 can evaluate liver reserve function better than CTP class and MELD score.
- hepatitis B /
- liver cirrhosis /
- indocyanine green

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参考文献(15)

[1]NIE QH.Clinical practice of antiviral treatment for liver cirrhosis patients with chronic hepatitis B[J].Chin J Pract Intern Med,2014,34(6):568-571.(in Chinese)聂青和.核苷酸类似物药物治疗乙型肝炎肝硬化的临床实践[J].中国实用内科杂志,2014,34(6):568-571.

[2]FENG HL,LI Q,WANG L,et al.Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure[J].Hepatobiliary Pancreat Dis Int,2014,13(3):271-275.

[3]LIU YR,FANG ZP,YANG W,et al.Clinical evaluation of liver storage function by indocyanine green retention test[J].Chin J Hepatol,2010,18(6):476-477.(in Chinese)刘义荣,范作鹏,杨薇,等.吲哚菁绿滞留测试对肝储备功能的评价[J].中华肝脏病杂志,2010,18(6):476-477.

[4] Chinese Society of Hepatology,Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J].J Chin J Intern Med,2011,50(2):168-179.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2010版)[J].中华内科杂志,2011,50(2):168-179.

[5]FUNG J,POON RT,YU WC,et al.Use of liver stiffness measurement for liver resection surgery:correlation with indocyanine green clearance testing and post-operative outcome[J].PLoS One,2013,8(8):e72306.

[6]MULLIN EJ,METCALFE MS,MADDERN GJ.How much liver resection is too much?[J].Am J Surg,2005,190(1):87-97.

[7] DONG JH,ZHENG SS,CHEN XP,et al.Consensus on evaluation of hepatic functional reserve before hepatectomy(2011 version)[J].Chin J Dig Surg,2011,10(1):20-25.(in Chinese)董家鸿,郑树森,陈孝平,等.肝切除术前肝脏储备功能评估的专家共识(2011版)[J].中华消化外科杂志,2011,10(1):20-25.

[8]KAMEI H,FUJIMOTO Y,NAGAI S,et al.Impact of non-congestive graft size in living donor liver transplantation:new indicator for additional vein reconstruction in right liver graft[J].Liver Transpl,2007,13(9):1295-1301.

[9]PAN Z,WU XJ,LI JS,et al.Functional hepatic flow in patients with liver cirrhosis[J].World J Gastroenterol,2004,10(6):915-918.

[10]CHENG XP,ZHAO J,CHEN Y,et al.Comparison of the ability of the PDD-ICG clearance test,CTP,MELD,and MELD-Na to predict short-term and medium-term mortality in patients with decompensated hepatitis B cirrhosis[J].Eur J Gastroenterol Hepatol,2016,28(4):444-448.

[11]SHENG QS,LANG R,HE Q,et al.Indocyanine green clearance test and model for end-stage liver disease score of patients with liver cirrhosis[J].Hepatobiliary Pancreat Dis Int,2009,8(1):46-49.

[12]CRDENAS A,GINS P.Predicting mortality in cirrhosis--serum sodium helps[J].N Engl J Med,2008,359(10):1060-1062.

[13]ZIPPRICH A,KUSS O,ROGOWSKI S,et al.Incorporating indocyanin green clearance into the Model for End Stage Liver Disease(MELD-ICG)improves prognostic accuracy in intermediate to advanced cirrhosis[J].Gut,2010,59(7):963-968.

[14]NI LD,HU F,CHENG ML,et al.Prognostic value of MELD-1CG in HBV/HCV cirrhosis:a prospective study[J].Chin Hepatol,2013,18(7):439-443.(in Chinese)倪鎏达,胡峰,程明亮,等.MELD-ICG对HBV/HCV肝硬化预后的评估价值[J].肝脏,2013,18(7):439-443.

[15]GUPTA S,CHAWLA Y,KAUR J,et al.Indocyanine green clearance test(using spectrophotometry)and its correlation with model for end stage liver disease(MELD)score in Indian patients with cirrhosis of liver[J].Trop Gastroenterol,2012,33(2):129-134.

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