吲哚菁绿清除试验对原发性肝癌患者术前肝脏储备功能的评估价值

Assessment value of indocyanine green clearance test for preoperative liver reserve function of patients with primary liver cancer

目的探讨吲哚菁绿(ICG)清除试验对原发性肝癌患者术前肝脏储备功能的评估价值。方法对71例肝癌患者和50名健康体检人员,用日本DDG-3300K分析仪及配套分析软件检测ICG15分钟清除率(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。两组均值比较采用t检验,多组均值比较采用方差分析,相关分析采用线性相关分析或Spearman等级相关分析。结果肝癌患者的ICGR15为(18.7±4.3)%较正常对照组(4.7±1.2)%升高,(t=-22.39,P<0.05)。CTP分级越高,肝癌患者ICGR15越高,差异有统计学意义(F=51.43,P<0.05),ICGR15与CTP分级呈正相关(r=0.722,P<0.05),与肝血流量、血浆清除率呈负相关(r=-0.889、-0.753,P<0.05)。不同ICGR15的肝癌患者的PT、INR、ALT、AST、Alb、TBil差异有统计学意义(t=3.39、61.9、2.62、3.19、69.0、40.5,P<0.05),ICGR15与PT、INR、AST、TBil呈正相关(r=0.665、0.527、0.316、0.721,P<0.05),与白蛋白呈负相关(r=-0.507,P<0.05),其中与PT、TBil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ICGR15评估肝脏储备功能优于CTP分级。

Objective To investigate the indocyanine green clearance test for preoperative liver reserve function of patients with primary liver cancer. Methods Fifty healthy people and 71 patients were enrolled as control group and study group, respectively. Indocyanine green clearance rate in 15 minutes （ICGR15）, hepatic function, blood routine test and abdominal ultrasound were measured in all patients, and the Child-Turcotte-Pugh （CTP） scores were calculated for classification. All data were analyzed by student＇s t-test, one-way analysis of variance and linear correlation analysis with SPSS 17. 0. Results 丁he levels of ICGR15 in patients with primary liver cancer （18. 7 土 4. 3） were higher than those in controls （4. 7 ± 1. 2） （_t = - 22. 39, P〈0 . 05）. Moreover, levels of ICGR15 were positively correlated with the CTP score （r= 0. 722, P〈0. 05） , but negatively correlated with hepatic blood flow （r= - 0. 889, P〈0. 05） and plasma clearance rate （r = - 0. 753, P〈0. 05）. Comparisons in levels of prothrombin time （PT） , international normalized ratio （INR）, alanine aminotransferase （ALT） , aspartate aminotransferase （AST） , albumin （Alb） and total bilirubin （TBil） among patients with different levels of ICGR15 showed statistically differences （t = 3. 39, 61. 9, 2. 62, 3. 19, 69. 0, 40. 5; P 〈 0. 05）. Meanwhile,levels of ICGR15 was positively correlated with the levels of PT,INR,AST and TBil （r= 0. 665,0. 527,0.316, 0.721; P〈0 . 05） , but negatively correlated with the levels of Alb （ r = - 0.507, P〈0 . 05）. Furthermore, ICGR15 showed strongest correlation with the levels of PLT and TBil. Conclusion The indocyanine green clearance test could dynamically reflect liver reserve function, which is more accurately than CTP classification.