吲哚菁绿排泄试验预测肝切除术后肝功能衰竭的价值

Value of indocyanine green excretion test in predicting hepatic failure after hepatectomy

目的 探讨吲哚菁绿排泄试验预测肝切除术后肝功能衰竭的价值.方法 回顾性分析2007年6月至2008年6月安徽省立医院128例行肝切除患者的临床资料.按照术后是否发生肝功能衰竭分为无肝功能衰竭组（110例）和肝功能衰竭组（18例）.应用脉动色素浓度法测定吲哚菁绿15 min滞留率（ICG R15）和有效肝血流量（EHBF）,进行肝功能Child评分、组织活性指数评分（HAI评分）,并检测临床生化指标及其他相关指标,分析各指标与术后肝功能衰竭的关系以筛选阳性预测指标.采用t检验、x^2检验、线性回归分析或Logistic回归模型分析检测数据.结果 无肝功能衰竭组ICG R15、肝功能Child评分、HAI评分分别为9%±4%、（5.6±0.7）分、（3.8±0.5）分,明显低于肝功能衰竭组的15%±6%、（6.1±0.8）分、（5.0±0.8）分;而无肝功能衰竭组EHBF为（1.2±0.2）L/min,明显高于肝功能衰竭组的（1.0±0.2）L/min（t=11.121,2.356,3.915,2.802,P＜0.05）.年龄≥65岁、ICG R15≥14%和EHBF＜1.0 L/min是肝切除术后发生肝功能衰竭的危险因素（x^2=4.758,9.709,5.362,P＜0.05）.ICG R15与EHBF呈负相关（r=-0.527,P＜0.05）;HAI评分与ICG R15呈正相关（r=0.638,P＜0.05）,与EHBF呈负相关（r=-0.445,P＜0.05）.结论 ICG R15和EHBF是预测肝切除术后肝功能衰竭的良好指标.ICG R15≥14%和EHBF＜1.0 L/min时行肝切除则患者术后更有可能发生肝功能衰竭.

Objective To assess the value of indocyanine green excretion test in predicting hepatic failure after hepatectomy. Methods The retention rate of indocyanine green at 15 minutes （ICG R15）, effective hepatic blood flow （EHBF） and clinical and biochemical parameters of 128 patients who received hepatectomy at the Affiliated Provincial Hospital of Anhui Medical University from June 2007 to June 2008 were detected by pulse dye densitometry. All patients were divided into non-hepatic failure group （n = 110） and hepatic failure group （n =18）. ICG R15, EHBF, Child＇s score, histology activity index （HAI） score, clinical and biochemical parameters and other indexes were analyzed to predict hepatic failure by the t test, chi-square test, linear regression analysis or regression model. The relationship between positive predictive indexes and HAI score was studied. Results Eighteen patients suffered from hepatic failure after operation. ICG R15, Child＇s score, HAI score of patients without hepatic failure were 9% ±4%, 5.6 ±0.7, 3.8 ±0.5, which were significantly lower than 15% ±6%,6.1 ± 0. 8, 5.0 ± 0. 8 of patients with hepatic failure （t = 11. 121,2. 356, 3. 915, P 〈 0.05）. EHBF of patients without hepatic failure was （1.2 ±0.2） L/min, which was significantly higher than （1.0 ±0.2） L/min of patients with hepatic failure （t = 2. 802, P 〈 0. 05）. In a logistic regression model, age ≥ 65 years, ICG R15 ≥ 14% and EHBF 〈 1.0 L/min were risk factors of postoperative hepatic failure （x2 = 4. 758, 9.709, 5. 362, P 〈 0.05）.ICG R15 was negatively correlated with EHBF （r =-0. 527, P 〈0.05）. HAI score was positively correlated with ICG R15 （r =0. 638, P 〈0.05）, while it was negatively correlated with EHBF （r =-0. 445, P 〈0. 05）.Conclusions ICG R15 and EHBF are good predictive indicators for hepatic failure after hepatectomy. Patients with ICG R15≥14% and EHBF 〈 1.0 L/min are prone to have postoperative hepatic failure.