吲哚菁绿清除试验及肝脏有效血流量评估慢性肝炎患者肝脏储备功能的意义

Significance of ICGR_(15) and EHBF in evaluating liver reserve function among patients with chronic hepatitis

目的探讨吲哚菁绿清除试验15 min滞留(ICGR15)、肝脏有效血流量(EHBF)评估慢性肝炎患者肝脏储备功能的临床价值。方法对82例慢性肝炎患者在治疗前行ICG清除试验和EHBF测定,同时检测患者ALT、TBil、Alb、PTA、CHE等指标。分别观察轻、中、重度患者;ALT正常与异常组患者;TBil正常与异常组患者的ICGR15、EHBF两项指标变化。对患者的ICGR15、EHBF进行受试者工作特征曲线分析,探讨ICG清除试验及EHBF对病情预测的价值。计量资料数据以中位数±四分位数间距表示,多组间比较采用Kruskal-Wallis H检验;两组间比较采用Mann-Whitney U检验。结果 (1)在轻度与重度、中度与重度患者间ICGR15、EHBF差异均有统计学意义(H值分别为5.0、12.0、25.0、29.0,P<0.05)。(2)在ALT正常与异常组间,ICGR15、EHBF的差异无统计学意义(U值为135.5、146.0,P值为0.089、0.155)。(3)在TBil正常与异常组间,ICGR15、EHBF的差异均有统计学意义(U值为68.0、84.0,P<0.05)。(4)轻度、中度、重度患者ICGR15、EHBF、ALT、TBil的AUC分别为:0.434、0.497、0.622、0.521;0.969、0.075、0.900、1.000;0.861、0.161、0.759、0.950。结论在肝功能定量试验中ICG清除试验是定量评估肝脏储备功能较为准确的方法,有利于及时采取积极有效的治疗措施,具有重要临床意义。

ObjectiveTo investigate the clinical values of indocyanine green （ICG） retention rate at 15 min （ICGR15） and effective hepatic blood flow （EHBF） in evaluating the liver reserve function among patients with chronic hepatitis. MethodsEighty-two patients with chronic hepatitis were included in the study. ICGR15 and EHBF were measured by pulse dye densitometry before treatment, and alanine aminotransferase （ALT）, total bilirubin （TBil）, albumin, prothrombin activity, and cholinesterase were also measured. ICGR15 and EHBF were monitored among mild, moderate, and severe patients, patients with normal ALT and abnormal ALT, and patients with normal TBil and abnormal TBil. The predictive values of ICGR15 and EHBF for patients′ conditions were analyzed by the receiver operating characteristic （ROC） curve. The continuous data were expressed as median±interquartile range. Comparison between more than two groups was made by Kruskal-Wallis H test; comparison between two groups was made by Mann-Whitney U test. ResultsICGR15 and EHBF showed significant differences between mild and severe patients and between moderate and severe patients （H=5.0 and 12.0, P〈0. 05 for both; H=25.0 and 29.0, P〈0.05 for both）. There were no significant differences in ICGR15 and EHBF between the patients with normal ALT and those with abnormal ALT （U=135.5, P=0.089; U=146.0, P=0.155）. ICGR15 and EHBF also showed significant differences between the patients with normal TBil and those with abnormal TBil （U=68.0, P〈0.05; U=84.0, P〈0.05）. The areas under the ROC curve of ICGR15, EHBF, ALT, and TBil were 0.434, 0.497, 0.622, and 0.521, respectively, in mild patients, 0.969, 0.075, 0.900, and 1000, respectively, in moderate patients, and 0.861, 0.161, 0.759, and 0.950, respectively, in severe patients. ConclusionsICG clearance test is an accurate method for quantitatively assessing the liver reserve function and is helpful for taking timely, effective intervention. This test is of great clinical significance.