造血干细胞移植对终末期肝病患者ICGR15的影响及意义

Effect of hematopoietic stem cells transplantation on ICGR15 in patients with end-stage liver disease

目的观察自体外周血CD^(34+)造血干细胞移植治疗不同Child-Pugh分级的终末期肝病(end-stage liver disease,ESLD)患者移植前及移植后3、6、12、36和60个月的吲哚氰绿15 min滞留率(indocyanine green retention rate at 15 min,ICGR15)变化情况。方法对内科严格保守治疗无效且已达到肝移植适应证的不同Child-Pugh分级的60例晚期肝硬化患者,采用自体外周血CD^(34+)造血干细胞移植,分别在移植前及移植后3、6、12、36和60个月进行ICGR15测定,并对各Child-Pugh分级组内的各时间点结果进行比较,以及比较各ChildPugh分级级组之间的ICGR15值变化率。结果各Child-Pugh分级组ICGR15值随时间延长均呈下降趋势,其中Child-Pugh A级组内:移植后6个月、12个月、36个月及60个月组与术前及移植后3个月组比较差异均具有统计学意义(P<0.05),但移植后3个月组与术前比较差异无统计学意义(P>0.05),而移植后12个月组与移植后60个月组比较差异有统计学意义(P<0.05)。Child-Pugh B级组内:移植后6个月、12个月、36个月及60个月组与术前及移植后3个月组比较差异均有统计学意义(P<0.05),移植后3个月组与术前比较差异也有统计学意义(P<0.05),移植后6个月组与12个月、36个月及60个月组比较差异均有统计学意义(P<0.05)。Child-Pugh C级组内:移植后6个月、12个月、36个月及60个月组与术前及移植后3个月组比较差异均有统计学意义(P<0.05),但移植后3个月组与术前比较差异无统计学意义(P>0.05),而移植后6个月组与12个月、36个月及60个月组比较差异均有统计学意义(P<0.05)。各Child-Pugh分级组之间ICGR15变化率比较差异无统计学意义(P>0.05)。结论自体外周血CD^(34+)造血干细胞移植能长期有效地改善ESLD患者的肝功能储备能力,提高手术安全性。

Objective To investigate the changes of indocyanine green retention rate at 15 minutes （ICGR15） of autologous peripheral blood CD34^＋ hematopoietic stem cells transplantation in end-stage liver disease （end-stage liver, disease, ESLD） patients with different Child-Pugh grades during before and after transplantation of 3, 6, 12, 36, and 60 months. Methods The CD34~ hematopoietic stem cells transplantation were performed in 60 cases of advanced liver cirrhosis with different Child-Pugh grades who were ineffectively treated with strictly conservative treatment and complied with the criterion of liver transplantation. The ICGR15 were performed before transplantation and in 3, 6, 12, 36 and 60 months after transplantation. And the results of each time point in each Child-Pugh classification group were compared, and the rate of change of ICGR15 value were compared between each Child-Pugh classification group. Results The ICGR15 values of the Child-Pugh grading groups all decreased with time. In Child A group, there were respectively significant differences between the 6 months, 12 months, 36 months, and 60 months groups after transplantation and preoperative and 3 months groups after transplantation （P〈0.05）, but there was no significant difference between preoperative and 3 months group after transplantation （P〉0.05）, and there was significant difference between the 12 months and the 60 months group after transplantation （P〈0.05）. As same as Child A group, there were also significant differences between that time groups in the Child B group （P〈0.05）, but there were also significant differences between the 3 months group after transplantation and preoperative （P〈0.05）, and there were respectively significant differences between the 6 months and 12 months, 36 months, and 60 months group after transplantation in the Child B group （P〈0.05）. Also in the Child C group, there were significant differences between that time groups （P〈0.05）, but there was no significant difference between preoperative and 3 months group after transplantation （P〉0.05）, and there were respectively significant differences between the 6 months and 12 months, 36 months, and 60 months group after transplantation （P〈0.05）. There was no significant difference in the rate of ICGR15 between Child-Pugh classification groups. Conclusion Autologous peripheral blood CD34^＋ hematopoietic stem cells transplantation can effectively improve the liver function reserve capacity of ESLD patients and improve the safety of operation for a long time.