吲哚菁绿清除试验对乙型肝炎肝硬化患者肝脏储备功能的评估价值

Value of indocyanine green test in evaluating liver reserve function in patients with hepatitis B cirrhosis

目的通过吲哚菁绿(ICG)清除试验评估乙型肝炎肝硬化患者肝脏储备功能,探讨ICG清除试验与Child-TurcottePugh(CTP)分级和MELD评分评价肝功能之间的关系。方法收集福建医科大学附属第一医院2012年1月-2015年1月住院的乙型肝炎肝硬化患者127例,进行ICG清除试验,计算患者的ICG血浆清除率值(K值)、有效肝血流量(EHBF)、ICG 15 min滞留率(ICG R15),以及CTP分级和MELD评分。组间比较采用方差分析,进一步两两比较采用LSD-t检验;相关性比较采用Spearman等级相关性分析;采用受试者工作特征曲线下面积(AUC)比较肝脏储备功能。结果乙型肝炎肝硬化患者CTP分级:A级患者63例,B级患者45例,C级患者19例。随着CTP分级升高,ICG R15逐渐增高,而EHBF和K值则逐渐降低,差异均有统计学意义(F值分别为146.96、91.26、40.94,P值均分别为0.001、0.003、0.005)。在评价肝功能方面ICG R15与MELD评分及CTP分级呈正相关(r值分别为0.525、0.838,P值均<0.01),与EHBF及K值呈负相关(r值分别为-0.703、-0.901,P值均<0.01)。ICG R15AUC为0.85,MELD评分AUC为0.65。结论 ICG消除试验能够准确动态反应肝脏储备功能,ICG R15评估肝脏储备功能优于CTP分级及MELD评分。

Objective To evaluate liver reserve function in patients with hepatitis B cirrhosis using indocyanine green（ ICG） clearance test,and to investigate the correlation of ICG clearance test with Child- Turcotte- Pugh（ CTP） class and the Model for End- Stage Liver Disease（ MELD） score in evaluating liver function. Methods A total of 127 patients with hepatitis B cirrhosis who were hospitalized in The First Affiliated Hospital of Fujian Medical University from January 2012 to January 2015 were enrolled. ICG clearance test was performed for all the patients,and the ICG plasma clearance（ K value）,effective liver blood flow（ EHBF）,and ICG retention at 15 minutes（ ICG R15）were calculated. CTP class and MELD score were also determined. An analysis of variance was used for comparison between groups,the least significant difference t- test was used for comparison between any two groups,Spearman rank correlation was performed for correlation analysis,and the area under the receiver operating characteristic（ ROC） curve was used to compare liver reserve function. Results Among all the patients with hepatitis B cirrhosis,63 had CTP class A,45 had CTP class B,and 19 had CTP class C hepatitis B cirrhosis. With the increasing CTP class,ICG R15 gradually increased,while EHBF and K value gradually decreased（ F = 146. 96,91. 26 and 40. 94,P =0. 001,0. 003 and 0. 005）. In the evaluation of liver function,ICG R15 was positively correlated with MELD score and CTP class（ r = 0. 525 and 0. 838,both P〈0. 01） and was negatively correlated with EHBF and K value（ r =- 0. 703 and- 0. 901,both P〈0. 01）. The area under the ROC curve was 0. 85 for ICG R15 and 0. 65 for MELD score. Conclusion ICG test can accurately and dynamically reflect liver reserve function,and ICG R15 can evaluate liver reserve function better than CTP class and MELD score.