吲哚菁绿清除试验对肝硬化患者肝脏储备功能的评估价值

Application of indocyanine green clearance test in the assessment of liver reserve in patients with liver cirrhosis

目的探讨吲哚菁绿(ICG)清除试验对肝硬化患者肝脏储备功能的评估价值。方法在64例肝硬化患者和50例正常体检人员,使用日本DDG‐3300K分析仪及配套分析软件检测ICG 15分钟滞留率(ICGR15),同时检测肝功能、血常规、腹部B超等,计算肝功能Child-Turcotte-Pugh(CTP)评分并分级;采用直线相关分析或Spearman等级相关分析。结果肝硬化患者ICGR15为(28.5±18.3)%,显著高于正常对照组[(4.7±1.2)%,P<0.05];随着CTP分级升高,肝硬化患者ICGR15越高,差异具有统计学意义(F=40.97,P<0.05);ICGR15与CTP分级呈正相关(r=0.650,P<0.05),与肝血流量或血浆清除率呈负相关(r=-0.715、r=-0.817,P<0.05);不同ICGR15的肝硬化患者血小板计数、凝血酶原时间国际标准化比值、ALT、前白蛋白、白蛋白和总蛋白之间差异具有统计学意义(F=23.44、F=14.05、F=33.63、F=25.3、F=10.58、F=23.51,P<0.05),ICGR15与凝血酶原时间和总蛋白水平呈正相关(r=0.537、r=0.487,P<0.05),与前白蛋白、白蛋白和ALT呈负相关(r=-0.498、r=-0.497、r=-0.272,P<0.05),其中与凝血酶原时间和前白蛋白相关性最强。结论 ICG清除试验能够较准确地动态反映肝脏储备功能,使用ICGRl5评估肝脏储备功能优于CTP分级。

Objective To estimate the value of indocyanine green （ICG） clearance test in the assessment for hver reserve function in patients with hver cirrhosis. Methods Fifty healthy persons were selected as control （control group）,and 64 patients with liver cirrhosis were recruited for this study. ICG retention rate at 15 min （ICGR15） was measured by DDG-3300K analyzer （Japan）. Meanwhile,all the patients received test of hepatic function,routine analysis of blood and abdominal ultrasound. The Child-Turcotte-Pugh （CTP） scores were calculat- ed for classification. Data were analyzed by linear correlation test and spearman rank correlation test. Results ICGR15 of patients with liver cirrhosis were higher than that in the controls [（28.5＂＋18.3） % vs. （4.7±1.2）%, P〈0.05];The higher the CTP scores,the higher the ICGR15 in patients with liver cirrhosis （F=40.97,P〈0.05）;IC- GR15 was positively correlated with the CTP scores （r=-0.650,P〈0.05） and negatively correlated with hepatic blood flow （r=-0.715,P〈0.05） and plasma clearance rates （r=-0.817,P〈0.05）;The levels of PLT counts,PT,INR,ALT, prealbumin,albumin and total protein （TP）in patients with different ICGR15 were statistically different （F=23.44, F=14.05, F=I 1.13, F=33.63, F=25.3, F =10,58, F =23.511 respectively,P〈0.05） ; ICGR15 was positively correlated with the levels of PT and TP （r=0.537 and r=0.487,P〈0.05） and negatively correlated with the levels of prealbumin, albumin and ALT （r=-0.498,r=-0.497 and r=-0.272,P〈0.05）,and the ICGR15 had the most significant correlation with the levels of PT and prealbumin. Conclusion The ICG clearance test can dynamically reveal hver reserve function in patients with liver cirrhosis.