吲哚氰绿清除试验及终末期肝病模型对肝衰竭患者早期预后的评估价值

Evaluation of Indocyanine Green Clearance test(ICGR_(15)) and Model for End-stage Liver Disease(MELD) for Estimation of Short-term Prognosis in Patients with Liver Failure

目的探讨ICG(吲哚氰绿)清除试验(ICGR15值)与终末期肝病模型(MELD评分)在肝衰竭患者预后评估中的相关性及临床应用价值。方法对102例肝衰竭患者计算MELD评分,同时检测血中ICG15min滞留率(ICGR15)。比较肝衰竭不同时期生存组与死亡组的MELD评分和ICGR15值,并评估两者的相关性及预测价值。结果 35例(34.3%)患者在90天内死亡,死亡组的MELD评分和ICGR15值均高于生存组(P<0.01)。相关性分析显示:MELD评分与ICGR15值呈正相关(r=0.274,P<0.01)。MELD评分和ICGR15值在评估患者90天预后的ROC曲线下面积(AUC)无统计学意义(Z=1.92,P>0.05)。生存分析表明MELD评分和ICGR15值均可有效预测肝衰竭患者90天的预后。结论 MELD评分及ICGR15值均可有效预测肝衰竭患者早期预后,两者之间存在相关性,在临床上联合使用有助于全面评估肝衰竭患者的早期预后。

Objective To investigate the correlations between indocyanine green clearance test（ICGR15） and MELD scores,and evaluate the prognostic value of them in patients with liver failure.Methods Totally 102 patients with liver failure were screened.MELD scores were calculated,and ICGR15 values were conducted by pulse dye densitograph analyzer（DDG）.ICGR15 values and MELD scores between survival group and died group were compared.Correlation between ICGR15 values and MELD scores was evaluated by Spearman test.The diagnostic accuracy of ICGR15 values and MELD scores for prediction of 90-day survival was assessed by receiver-operating characteristic（ROC） curve analysis.Results 34.3% of the patients died within 90 days.MELD scores and ICGR15 values for deaths were higher than those for survivors significantly（P0.01）.Positive correlation was observed between ICGR15 values and MELD scores（r=0.274）.ROC analysis revealed MELD scores were equal to ICGR15 values for short-term prognosis.Specificity of the former was superior to that of the latter,but sensitivity was inferior.Conclusion Both MELD scores and ICGR15 values can accurately predict the short-term prognosis of patients with liver failure.ICGR15 value has positive correlation with MELD scores.Combing MELD scores with ICGR15 values might be helpful in predicting the short-time outcome in liver failure.