脉冲式色素浓度分析法吲哚菁绿清除试验在肝衰竭患者预后判断中的价值

Evaluation of indocyanine green clearance test for estimation of prognosis in patients with liver failure

目的探讨以吲哚菁绿清除试验15min滞留率(ICGR15)为指标评价肝衰竭患者的肝脏储备功能并判断其预后。方法根据出院时的临床转归将126例肝衰竭患者分为治愈好转组79例及未愈组47例,另取肝衰竭倾向患者24例作为对照。用脉冲式色素浓度分析法(PDD法)检测患者的ICGR15(单位为%)。结果 ICGR15基本数值与动态数值判断肝衰竭预后的ROC曲线下面积(AUC)分别为0.802及0.917,ICGR15基本数值的诊断临界值为54.7,敏感度0.766,特异度0.686,ICGR15动态数值的诊断临界值为56.75,敏感度0.957,特异度0.814;肝衰竭及肝衰竭倾向患者ICGR15基本数值分别为55.51±12.15和44.99±10.48,差异有统计学意义(t=3.969,P<0.001);肝衰竭患者好转组ICGR15基本数值及动态数值分别为50.85±10.32和50.49±9.14,未愈组分别为63.34±10.98和68.36±10.80,两组间ICGR15基本数值及动态数值比较差异均有统计学意义(t=6.416,P<0.001;t=9.909,P<0.001);好转组患者的ICGR15动态数值以基本不变或下降为主,未愈组患者则以上升为主,两组的变化趋势比较,差异有统计学意义(χ2=27.862,P<0.001)。结论对肝衰竭患者进行ICG清除试验,其ICGR15数值尤其是其变化趋势可以作为评价患者肝脏功能及疾病严重程度的指标,也可以作为判断预后的良好指标。

Objective To investigate the importance of indocyanine green （ICG） retention at fifteen minutes （ICGR15） for hepatic reserve function in patients with liver failure. Methods According to clinical outcome at discharge, 126 patients with liver failure were divided into 2 groups： a cured or improved group （79 cases） and an unimproved group （47 cases）. 24 patients whose liver had the tendency to become failure served as control. The ICGR15 （%） was measured by pulse dye densitometry （PDD）. Results The area under the ROC curve （AUC） of basic ICGR15 values and dynamic ICGR15 value used to predict the prognosis of liver failure were 0. 802 and 0. 917 respectively. For basic ICGR15 value, its diagnostic cut off value and sensitivity as well as specificity were 54.7%, 0. 766 and 0. 686, while for dynamic ICG-R15 value, they were 56.7%, 0. 957 and 0. 814 respectively. The basic ICGR15 value was 55.5±12. 15 in patients with liver failure and 44.99±10.48 in patients with tendency of liver failure. The difference was statistically significant （t= 3. 969, P〈0. 001）. The basic ICGR15 value and the dynamic value in the cured or improved group were 50.85~10.32 and 50.49_＋_9.14 compared to the values of 63.34±10.98 and 68.36±10.80 in the unimproved group The differences were also statistically significant （t=6.416, P〈0.001; t=9. 909, P〈0.001）. The dynamic ICGR15 values remained relatively unchanged or decreased in the cured or improved group, whereas these values increased in the unimproved patients （X2= 27. 862, P〈0. 001）. Conclusions The ICGR15 values especially with changing patterns in liver failure patients are good indicators used to evaluate liver function and to estimate prognosis.